BLS Healthcare Provider Pediatric Cardiac Arrest Algorithm for 2 or More Rescuers—2015 Update

This flowchart shows the BLS Healthcare Provider Pediatric Cardiac Arrest Algorithm for 2 or More Rescuers, as updated in 2015. It begins at the top with a green box that says, “Verify scene safety.” From here, an arrow points downward to an orange box that states, “Victim is unresponsive. Shout for nearby help. First rescuer remains with victim. Second rescuer activates emergency response system and retrieves A.E.D. and emergency equipment.” The next arrow leads to a red hexagon. It says, “Look for no breathing or only gasping and check pulse (simultaneously.)” It then asks, “Is pulse definitely felt within 10 seconds?” From here, the flowchart branches in three directions. If the answer to the question is that the patient is breathing normally and has a pulse, follow the arrow to the left. A green box says, “Monitor until emergency responders arrive.” If the answer is that the patient is not breathing normally and has a pulse, follow the arrow to the right. This green box contains the following text: “Provide rescue breathing: 1 breath every 3 to 5 seconds, or about 12 to 20 breaths per minute.

• Add compressions if pulse remains less than or equal to 60 beats per minute with signs of poor perfusion.
• Activate emergency response system (if not already done) after 2 minutes.
• Continue rescue breathing; check pulse about every 2 minutes. If no pulse, begin CPR. (Go to “CPR” box.)”

If the answer is that the patient is not breathing or only gasping and does not have a pulse, follow the arrow downward to the CPR box mentioned earlier. This blue box states: “First rescuer begins CPR with 30-to-2 ratio (compressions to breaths). When second rescuer returns, use 15-to-2 ratio (compressions to breaths). Use A.E.D. as soon as it is available.” From the CPR box, an arrow points downward to another red hexagon, which says, “A.E.D. analyzes rhythm. [Is it a] shockable rhythm?” If the answer is “Yes,” follow the arrow down to the left to the blue box that instructs: “Give 1 shock. Resume CPR immediately for about 2 minutes (until prompted by A.E.D. to allow rhythm check). Continue until A.L.S. providers take over or victim starts to move.” If the answer is “No,” follow the arrow down to the right to the blue box that states: “Resume CPR immediately for about 2 minutes (until prompted by A.E.D. to allow rhythm check.) Continue until A.L.S. providers take over or victim starts to move.” Whether the answer was “Yes” or “No,” these boxes point back to the red hexagon that says, “A.E.D. analyzes rhythm. [Is it a] shockable rhythm?” This figure is copyright 2015 by the American Heart Association.