Paeds · acute-care-resuscitation-and-toxicology
Paediatric basic and advanced life support
Also known as Paediatric CPR · Paediatric life support algorithm · Paediatric resuscitation · Paediatric advanced life support · PALS · ANZCOR paediatric algorithm
Fellowship guide to paediatric basic and advanced life support: the BLS sequence, high-quality chest compressions, the airway and ventilation ladder, defibrillation at 4 J per kilogram, adrenaline at 10 micrograms per kilogram, reversible causes, and post-arrest care.
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Target exams
Red flags
- Child or infant unresponsive and not breathing normally after airway opening
- Heart rate under 60 beats per minute with poor perfusion in an infant — start chest compressions
- No chest rise despite corrective steps — airway or ventilation failure
- Shockable rhythm on the monitor — ventricular fibrillation or pulseless ventricular tachycardia
- Apnoeic or gasping child with a history consistent with asphyxia, drowning or airway obstruction
- Inadequate chest compression depth, rate or fraction — the commonest reversible quality failure
- Persisting bradycardia or asystole without reversible-cause search and correction
- Return of spontaneous circulation with fever or hyperoxia — both worsen neurological outcome
Life stages
Care settings
Clinical exam formats
Board mappings
- Recognition of the deteriorating child and structured ABCDE assessment
- Paediatric basic life support sequence for infant and child
- Choking child algorithm and relief of foreign-body airway obstruction
- Paediatric advanced life support algorithm with defibrillation and drug doses
- Airway management including bag-mask ventilation and supraglottic devices
- Post-arrest stabilisation and targeted temperature management
- BLS and ALS doses, ratios, depths and defibrillation thresholds
- High-quality CPR metrics and team human factors
- Recognition and management of shockable versus non-shockable rhythms
- Short case: child in cardiac arrest requiring algorithm leadership
- Communication with the family during and after an arrest
- Acute care: paediatric life support and resuscitation
- Identification and management of the deteriorating child
- Safe transfer and stabilisation after return of spontaneous circulation
- Paediatric basic and advanced life support algorithms
- Pharmacology: adrenaline, amiodarone, lidocaine and fluids in arrest
- Evidence base and guideline sources for paediatric resuscitation
- Paediatric resuscitation scenario station
- Communication: breaking bad news after cardiac arrest
- Pediatric basic and advanced life support (PALS)
- High-quality chest compression and ventilation
- Recognition and management of shockable rhythms and reversible causes
- Patient Care: paediatric resuscitation and stabilisation
- Medical Knowledge: asphyxial arrest physiology and defibrillation
- Systems-Based Practice: team leadership and post-arrest transfer
- Medical Expert: paediatric advanced life support
- Collaborator: multidisciplinary resuscitation team leadership
- Health Advocate: bystander CPR and community readiness
Overview & Definition
A two-year-old is pulled blue and limp from a swimming pool. The clock has started, the algorithm must take over, and the decisions made in the next minute decide whether that child lives and how they live afterwards. Paediatric basic and advanced life support is the structured sequence of actions used to recognise, support and reverse cardiopulmonary arrest in an infant or child. Basic life support is the airway, breathing and circulation a single rescuer or a parent can deliver; advanced life support adds defibrillation, vascular access, drugs, an advanced airway and the search for reversible causes. [1] [6]
The single most important difference from adult resuscitation is the cause. Adults arrest most often from a sudden primary cardiac arrhythmia — ventricular fibrillation — in a heart that is still well oxygenated. Children arrest most often from a progressive asphyxial pathway: the airway obstructs or breathing fails, oxygen falls, bradycardia follows, and the heart stops only after the body is already deeply hypoxic. That difference drives the whole algorithm — it is why rescue breaths come before compressions, why compressions run at fifteen to two rather than thirty to two, and why ventilation quality matters as much as compression quality. [1] [2]
Holding the algorithm in your head means holding two ladders at once. The basic life support ladder climbs from responsiveness to airway to breathing to compressions. The advanced life support ladder adds rhythm recognition, defibrillation, vascular access, adrenaline and reversible-cause correction, looping every two minutes. The two run together, and the team that runs them well does so with clear roles, a leader, and a timer calling each cycle. [1]
References12ShowHide
- [1]Topjian AA Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 2021.PMID 33087552
- [2]Maconochie IK European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation, 2021.PMID 33773830
- [3]Olasveengen TM 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation, 2022.PMID 34813356
- [4]Atkins DL 2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality. Circulation, 2018.PMID 29114009
- [5]Duff JP 2018 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2018.PMID 30571264
- [6]Maconochie IK European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support. Resuscitation, 2015.PMID 26477414
- [7]Matos RI Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrest. Circulation, 2013.PMID 23339874
- [8]Valdes SO Lidocaine versus amiodarone for pediatric in-hospital cardiac arrest: An observational study. Resuscitation, 2020.PMID 31954741
- [9]Moler FW Therapeutic Hypothermia in Children. N Engl J Med, 2015.PMID 26332558
- [10]Moler FW Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children. N Engl J Med, 2017.PMID 28118559
- [11]Goto Y Dispatcher-assisted conventional cardiopulmonary resuscitation and outcomes for paediatric out-of-hospital cardiac arrest. Resuscitation, 2022.PMID 34648920
- [12]Lin S Adrenaline for out-of-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials. Resuscitation, 2014.PMID 24642404