PEA As x C2RC C2 RC C2 RC x PUSH ADR EARLY THEN EVERY OTHER LOOPX 4H 4T SBC

Non-shockable (asystole or PEA):

This is the more common finding in children.

• Perform continuous CPR:    C2
  • Continue to ventilate with high-concentration oxygen.
  • If ventilating with bag-mask give 15 chest compressions to 2 ventilations.
  • Use a compression rate of 100–120 min-1.
  • If the patient is intubated, chest compressions can be continuous as long as this does not interfere with satisfactory ventilation.
  • Once the child's trachea has been intubated and compressions are uninterrupted use a ventilation rate of approximately 10–12 min-1. Note: Once there is return of spontaneous circulation (ROSC), the ventilation rate should be 12–20 min-1. Measure end-tidal carbon dioxide (CO2) to monitor ventilation and ensure correct tracheal tube placement.
• Give adrenaline: PUSH EARLY AD -PEA As
  • If vascular access has been established, give adrenaline 10 mcg kg-1 (0.1 mL kg-1 of 1 in 10,000 solution).
  • If there is no circulatory access, obtain intraosseous (IO) access.
• Continue CPR, only pausing briefly every 2 min to check for rhythm change.
  • Give adrenaline 10 mcg kg-1 every 3–5 min (i.e. every other loop), while continuing to maintain effective chest compression and ventilation without interruption
  • . C2RC C2 RC C2 RC 
• Consider and correct reversible causes (4Hs and 4Ts):
• Hypoxia
• Hypovolaemia
• Hyper/hypokalaemia, metabolic
• Hypothermia
• Thromboembolism (coronary or pulmonary)
• Tension pneumothorax
• Tamponade (cardiac)
• Toxic/therapeutic disturbance