In managing a child experiencing cardiac arrest, immediate initiation of paediatric advanced life support (PALS) protocols is essential, focusing on high-quality chest compressions and early defibrillation when indicated. The UK guidelines emphasise urgent emergency medical care activation (999 ambulance) for any child with life-threatening features, including cardiac arrest, ensuring rapid access to advanced resuscitation NICE NG143. Initial assessment should prioritise airway, breathing, and circulation, with prompt initiation of chest compressions if the child is unresponsive and not breathing normally NICE NG143. The use of age-appropriate defibrillation energy doses and airway management techniques, including bag-mask ventilation or advanced airway placement, should follow established PALS algorithms NICE NG143. Intravenous or intraosseous access should be established quickly to administer emergency medications such as adrenaline, following paediatric dosing guidelines NICE NG143. Continuous monitoring of heart rhythm and response to interventions is critical, with adjustments made according to the child’s clinical status and rhythm changes Berg et al. 2020. The literature highlights the importance of a systems-based approach to paediatric cardiac arrest, including post-resuscitation care and involvement of critical care specialists to optimise outcomes Berg et al. 2020. Additionally, recognition and management of underlying causes such as arrhythmias or sepsis should be integrated into the resuscitation process (Cepeda-Nieto et al., 2025; NG51 3). Emotional and psychological support for the child and family should be considered throughout, especially if the child has life-limiting conditions (NG61 2). In summary, follow UK emergency paediatric resuscitation guidelines with rapid assessment, high-quality CPR, early defibrillation, medication administration, and specialist referral, while incorporating evidence-based practices from recent literature on paediatric cardiac arrest care Berg et al. 2020Cepeda-Nieto et al. 2025 NICE NG143,NICE NG61,NICE NG51Berg et al. 2020Cepeda-Nieto et al. 2025.
Key References
- NG143 - Fever in under 5s: assessment and initial management
- NG61 - End of life care for infants, children and young people with life-limiting conditions: planning and management
- NG51 - Suspected sepsis: recognition, diagnosis and early management
- (Bar-Cohen and Silka, 2008): Sudden cardiac death in pediatrics.
- (Berg et al., 2020): Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
- (Cepeda-Nieto et al., 2025): Pediatric arrhythmias: a comprehensive integrative review, symptom-based conceptual framework, and practical care guide.