Cardiorespiratory arrest and post-arrest care — formative SAQs

SAQ 1 (10 marks)

A 6-year-old boy collapses in the emergency department. He is unresponsive, not breathing normally and has no pulse. The monitor shows ventricular fibrillation. You have trained staff and a defibrillator. ^[2]

Question. Outline the first minutes of resuscitation, including compressions, shocks and drugs, following the ERC 2025 algorithm. State where the AHA 2025 guideline differs. (10 marks) ^{[1] [2]}

Model answer

The ERC sets compressions at 100 to 120 per minute, depressing the chest by at least one third of its anteroposterior depth. Trained rescuers use a compression-to-ventilation ratio of 15:2. ^[2]

For a shockable rhythm, the ERC gives one shock of 4 J/kg (maximum 120 to 200 J) and resumes CPR immediately for 2 minutes. Give adrenaline 10 µg/kg (maximum 1 mg) and amiodarone 5 mg/kg (maximum 300 mg) IV/IO immediately after the third shock. After the fifth shock, give a second adrenaline dose and amiodarone 5 mg/kg (maximum 150 mg). Lidocaine 1 mg/kg IV is an alternative. ^[2]

The AHA considers an initial dose of 2 to 4 J/kg reasonable, with 2 J/kg for ease of teaching, and states that subsequent doses of 4 J/kg may be reasonable for refractory VF/pVT. It states that it may be reasonable to administer epinephrine after 2 attempts at defibrillation, or sooner only if rapid defibrillation is not possible. ^[1]

The AHA does not recommend routine sodium bicarbonate or calcium, except in special circumstances. ^[1]