Adult Foreign-Body Airway Obstruction

Verify scene safety.

• Encourage cough. Check for signs of severe FBAO

Absent
• Continue to check for • Weak or absence of cough
signs of severe FBAO. • Unable to speak
• Change in color (cyanosis)
• Altered mental status
• Apnea

Present

Activate emergency
response system.

Start repeated cycles of

• 5 back blows (slaps), followed by Yes
• 5 abdominal thrusts* Is the adult
• Repeat until object is expelled or the responsive?
adult becomes unresponsive.
• If object is expelled, continue to
monitor until advanced care arrives. No

Start CPR until advanced care

arrives; refer to
adult BLS algorithm.
• Start with compressions.
• Check for visible object in
mouth before giving breaths.

*For patients in the late stages of pregnancy, or when the rescuer is unable to encircle
the patient’s abdomen, 5 chest thrusts should be used instead.

© 2025 American Heart Association

 Act Now. Save a Life.
Follow these steps to take action.

Unresponsive
No breathing, abnormal
breathing (eg, gasping)

Activate
emergency Get AED.
response.
AED

Start CPR.

Apply AED
pads. Follow
AED prompts.
Resume CPR
for 2 minutes. AED

Press hard. Press fast If suspected opioid

in the center of the chest. overdose, give a dose of
naloxone (if available).
Resume CPR.

© 2025 American Heart Association

Adult* Basic Life Support Algorithm for Health Care Professionals

Verify scene safety.

• Check for responsiveness.

• Shout for nearby help.
• Activate emergency response system.
• Send someone to get AED/defibrillator.

Normal Abnormal
• Provide breaths, 1 breath every
breathing, Look for no breathing breathing,
6 seconds or 10 breaths/min.
Monitor until pulse felt or only gasping, and check pulse felt
• Check pulse every 2 minutes;
advanced care pulse (simultaneously). if no pulse, start CPR.
arrives. Is pulse definitely felt • If suspected opioid overdose,
within 10 seconds? administer opioid antagonist
(eg, naloxone) if available.

No breathing
or only gasping,
pulse not felt

Start CPR
• Perform cycles of 30 compressions
and 2 breaths.
• Use AED/defibrillator as soon as it
is available.
• If suspected opioid overdose,
consider opioid antagonist
(eg, naloxone).

AED arrives.

Check rhythm.
Shockable rhythm?
Yes, No,
shockable nonshockable

• Give 1 shock. Resume CPR • Resume CPR immediately for 2

immediately for 2 minutes (until minutes (until prompted by AED/
prompted by AED/defibrillator to defibrillator to allow rhythm check).
allow rhythm check). • Continue until ALS professionals
• Continue until ALS professionals take over or person starts to move.
take over or person starts to move.

*If signs of puberty, treat as adult.

© 2025 American Heart Association

BLS/Universal Termination of Resuscitation Rules

Arrest not witnessed by emergency medical services personnel

No return of spontaneous circulation (before transport)
No AED shock was delivered (before transport)

If all criteria are present, If any criteria are not

consider termination present, continue
of resuscitation. resuscitation and
consider transport.
© 2025 American Heart Association
Adult Cardiac Arrest Circular Algorithm

High-Quality CPR

• Push hard (at least 2 inches [5 cm]).

• Push fast (100-120/min) and allow complete chest recoil.
• Minimize interruptions in compressions.
Start CPR • Avoid excessive ventilation.
• Begin bag-mask ventilation • Change compressor every 2 minutes, or sooner if fatigued.
and give oxygen • If no advanced airway, 30:2 compression-ventilation ratio.
• Attach monitor/defibrillator • If advanced airway in place, give 1 breath every 6 seconds
(10 breaths/min) with continuous chest compressions.
Return of spontaneous • Continuous waveform capnography
2 minutes circulation (ROSC) – If ETCO2 is low or decreasing, reassess CPR quality.
Check Post–Cardiac Shock Energy for Defibrillation
Rhythm Arrest Care
If VF/pVT • Biphasic: Manufacturer recommendation (eg, initial dose of
Shock
120-200 J); if unknown, use maximum available. Second and
subsequent doses should be equivalent, and higher doses may
Drug Therapy
IV/IO access be considered.
Co
• Monophasic: 360 J
R

Epinephrine every 3-5 minutes

uous CP

Amiodarone or lidocaine
ntinuous CP

for refractory VF/pVT Drug Therapy

• Epinephrine IV/IO dose: 1 mg every 3-5 minutes

Consider Advanced Airway • Amiodarone IV/IO dose: First dose: 300 mg bolus. Second
Quantitative waveform capnography
ntin

dose: 150 mg.

or
• Lidocaine IV/IO dose: First dose: 1-1.5 mg/kg. Second dose:
o

Treat Reversible Causes

R
C

0.5-0.75 mg/kg.

Advanced Airway
Mo
nitor C ity
P R q u al • ET intubation or supraglottic advanced airway
• Continuous waveform capnography or capnometry to confirm
and monitor ET tube placement
• Once advanced airway in place, give 1 breath every 6 seconds
(10 breaths/min) with continuous chest compressions

Reversible Causes

• Hypovolemia • Tension pneumothorax

• Hypoxia • Tamponade, cardiac
• Hydrogen ion (acidosis) • Toxins
• Hypo-/hyperkalemia • Thrombosis, pulmonary
• Hypothermia • Thrombosis, coronary
© 2025 American Heart Association
Adult Cardiac Arrest Algorithm (VF/pVT/Asystole/PEA)

1
High-Quality CPR
Start CPR
• Begin bag-mask ventilation • Push hard (at least 2 inches
and give oxygen [5 cm]).
• Attach monitor/defibrillator • Push fast (100-120/min)
and allow complete chest recoil.
• Minimize interruptions in
compressions.
• Avoid excessive ventilation.
Yes Rhythm No • Change compressor every
shockable? 2 minutes, or sooner if fatigued.
• If no advanced airway, use 30:2
2 9 compression-ventilation ratio.
• If advanced airway in place, give
VF/pVT Asystole/PEA 1 breath every 6 seconds
(10 breaths/min) with continuous
chest compressions.
• Continuous waveform
3 Shock Epinephrine capnography
ASAP – If ETCO2 is low or decreasing,
reassess CPR quality.
4 10
Shock Energy for Defibrillation
CPR 2 min CPR 2 min
• IV/IO access • Biphasic: Manufacturer
• IV/IO access
• Epinephrine every 3-5 min recommendation (eg, initial
• Consider advanced airway, dose of 120-200 J); if unknown,
capnography use maximum available.
Second and subsequent doses
Rhythm No should be equivalent, and higher
shockable? doses may be considered.
• Monophasic: 360 J
Rhythm Yes
Yes Drug Therapy
shockable?
5 Shock • Epinephrine IV/IO dose:
1 mg every 3-5 minutes
No • Amiodarone IV/IO dose:
6 First dose: 300 mg bolus
CPR 2 min Second dose: 150 mg
or
• Epinephrine every 3-5 min Lidocaine IV/IO dose:
• Consider advanced airway, First dose: 1-1.5 mg/kg
capnography Second dose: 0.5-0.75 mg/kg

Advanced Airway

No • ET intubation or supraglottic
Rhythm advanced airway
shockable? • Continuous waveform
capnography or capnometry
Yes to confirm and monitor ET tube
placement
7 Shock
Reversible Causes

• Hypovolemia
8 11 • Hypoxia
CPR 2 min CPR 2 min • Hydrogen ion (acidosis)
• Amiodarone or lidocaine • Hypo-/hyperkalemia
• Treat reversible causes • Hypothermia
• Treat reversible causes
• Tension pneumothorax
• Tamponade, cardiac
• Toxins
No Yes • Thrombosis, pulmonary
Rhythm • Thrombosis, coronary
shockable?

12
• If no signs of ROSC, go Go to 5
to 10
• If ROSC, go to post–
cardiac arrest care
• Consider appropriateness
of continued resuscitation

© 2025 American Heart Association

 Adult Post–Cardiac Arrest Care Algorithm Initial Stabilization After ROSC
Resuscitation is ongoing during the post-
ROSC obtained ROSC phase, and many of these activities
can occur concurrently.
Manage airway: Assess and consider
placement or exchange of an advanced
Manage airway airway device (usually endotracheal tube
Assess airway. or supraglottic device). Confirm correct
Place or exchange an advanced airway device, placement of an advanced airway. This
as necessary. generally includes the use of waveform
Confirm correct airway placement. capnography or capnometry.
Manage oxygenation and ventilation:
Manage oxygenation and ventilation Titrate Fio2 for Spo2 90%-98% (or Pao2
Initial Maintain 100% Fio2 until Spo2 (or Pao2) can be 60-105 mm Hg). Adjust minute ventilation
stabilization measured reliably. to target Pco2 35-45 mm Hg in the
after ROSC Spo2 target 90%-98% (Pao2 60-105 mm Hg) absence of severe acidemia.
Pco2 target 35-45 mm Hg Manage hemodynamics: Initiate
or adjust vasopressors and/or fluid
Manage hemodynamics resuscitation as necessary for goal MAP
≥65 mm Hg.
Target MAP ≥65 mm Hg
Early diagnostic testing: Obtain 12-lead
ECG to assess for ischemia or arrhythmia.
Consider CT head, chest, abdomen, and/
Early diagnostic testing or pelvis to determine cause of arrest
Obtain 12-lead ECG. or assess for injuries sustained during
Consider diagnostic imaging resuscitation. Point-of-care ultrasound
(CT and/or ultrasound). or echocardiography may be reasonable
to identify clinically significant diagnoses
requiring intervention.

Continued Management
Treat arrest etiologies and complications.
Consider emergency coronary angiography Treat arrest etiologies and
and/or mechanical circulatory support. complications.
Consider emergency cardiac
intervention:
• Persistent ST-segment elevation
Assess patient off sedation and present
neuromuscular blockade, if able. • Cardiogenic shock
• Recurrent or refractory ventricular
arrhythmias
• Severe myocardial ischemia
Follows
Temperature control: If patient is not
Continued No or commands?
Yes following commands off sedation and
management unsure
neuromuscular blockade or is unable to
assess, initiate a deliberate strategy of
Ongoing critical care Ongoing critical care temperature control with goal 32 °C-37.5 °C
as soon as possible.
Deliberate strategy for Coronary angiography Evaluate for seizure: Evaluate for clinical
temperature control when appropriate seizure and obtain EEG to evaluate
for seizure in patients not following
commands.
EEG Prognostication: Multimodal approach
with delayed impressions (≥72 hours from
ROSC or achieving normothermia).
Coronary angiography
when appropriate Ongoing critical care includes the
following:
• Target Pao2 60-105 mm Hg, Pco2 35-45
Appropriately timed, mm Hg (unless severe acidemia); avoid
multimodal prognostication hypoglycemia (glucose <70 mg/dL) and
hyperglycemia (glucose >180 mg/dL);
target MAP ≥65 mm Hg.
• Consider antibiotics.
© 2025 American Heart Association
Cardiac Arrest in Pregnancy Algorithm

Start BLS/ALS Explanation of Cardiac Arrest

Interventions
• Provide high-quality CPR.
• Provide continuous left lateral uterine displacement • Cardiac arrest in pregnancy
when the fundal height is at or above the umbilicus. team will vary according to local
• Use AED/defibrillator when indicated. resources but may include
– Team Leader
– Anesthesiologist
– Obstetrician
– Neonatologist
– Nurses
Activate cardiac arrest in
– Pharmacists
pregnancy team – Other professionals
• Address etiology of arrest. • The goal of left lateral uterine
displacement is to relieve
aortocaval compression and
to facilitate effective chest
compressions.
• The goal of resuscitative delivery is
Optimize resuscitation in Prepare for to improve the pregnant patient’s
pregnancy resuscitative delivery outcome, and when feasible, the
• Prioritize early airway When fundal height is at newborn infant's outcome.
management. or above the umbilicus • Ideally, perform resuscitative
• Place IV above diaphragm. delivery by 5 minutes, depending on
local resources.
• If receiving IV magnesium, stop
• In pregnancy, difficult airway
magnesium and give calcium.
is common and is managed
• Detach fetal monitors. (eg, endotracheal intubation or
• Activate massive blood supraglottic airway) by the most
transfusion protocol if amniotic experienced professional.
fluid embolism suspected.
Etiologies of Cardiac Arrest

A Anesthetic complications
B Bleeding
C Cardiovascular
Goal is delivery by 5
D Drugs
minutes if no ROSC
E Embolic (amniotic fluid or
pulmonary embolism)
F Fever
G General causes (H’s and T’s)
Resuscitate newborn H Hypertension (eg, preeclampsia)
Continue ALS.
infant using the Neonatal
Resuscitation Algorithm.

© 2025 American Heart Association

Adult and Pediatric Durable Left Ventricular Assist Device Algorithm

Assessing Perfusion
Unresponsive adults and children
with a durable LVAD Adequate perfusion* if any of the
following present:
• Assist ventilation, if necessary
• Normal skin color and
• Assess perfusion temperature
• Normal capillary refill
• MAP >50 mm Hg (if noninvasive
BP cuff nonfunctional, use
doppler or arterial line, if
Yes No available)
Adequate perfusion? • Petco2 >20 mm Hg (if available
and should be used only when
an ET tube or tracheostomy is
used to ventilate the patient;
use of a supraglottic [eg, King]
airway results in a falsely
Do not perform Perform external chest elevated Petco2 value)
external chest compressions *Patients may not have palpable pulse
compressions • Assess LVAD Non-LVAD Causes of
• Assess and treat function, if second Unresponsiveness
non-LVAD causes of rescuer available
unresponsiveness • Assess and treat • Dysrhythmia
non-LVAD causes for • Hemorrhage/hypovolemia
unresponsiveness • Hypoglycemia
• Hypoxia
• Overdose
• Right ventricular failure
• Sepsis
Monitor perfusion
• Stroke

Continue BLS/ALS Assess and Attempt to Restart

LVAD Function

• Look/listen for alarms

• Listen for LVAD hum
• Driveline connected?
Transport • Power source connected?
• Need to replace system
Contact VAD center controller?
• Continue to
monitor perfusion

© 2025 American Heart Association

ALS Termination of Resuscitation

Arrest not witnessed

No bystander CPR
No return of spontaneous circulation (before transport)
No shock was delivered (before transport)

If all criteria are present, If any criteria are not

consider termination present, continue
of resuscitation. resuscitation and
consider transport.
© 2025 American Heart Association
Adult Tachyarrhythmia With a Pulse Algorithm

Assess appropriateness of heart rate Doses/Details

for clinical condition. Heart rate typically Synchronized cardioversion:
≥150/min if tachyarrhythmia. Refer to your specific device’s recommended energy level or to
relevant 2025 Guidelines sections to maximize first shock success.
If not known, use the maximum energy setting.
Adenosine IV dose:
First dose: 6 mg rapid IV push; follow with NS flush.
Initial assessment and support Second dose: 12 mg if required.
• Maintain patent airway; assist breathing as necessary Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia
• Oxygen (if hypoxemic) Procainamide IV dose:
• Continue cardiac monitoring to identify rhythm;
20-50 mg/min until arrhythmia suppressed, hypotension ensues,
monitor blood pressure and oximetry
QRS duration increases >50%, or maximum dose 17 mg/kg given.
• IV access
Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.
• 12-lead ECG, if available
Amiodarone IV dose:
First dose: 150 mg over 10 minutes. Repeat as needed if VT recurs.
Follow by maintenance infusion of 1 mg/min for first 6 hours.

Persistent tachyarrhythmia
causing
Yes Synchronized cardioversion
• Hypotension?
• Sedate whenever feasible
• Acutely altered mental status?
• Signs of shock? • If regular narrow complex,
consider adenosine If refractory, consider
• Ischemic chest discomfort?
• Underlying cause
• Acute heart failure?
• Need to increase
energy level for next
No cardioversion
• Addition of anti-
Consider arrhythmic drug
Yes • Adenosine only if regular • Expert consultation
Wide QRS?
≥0.12 second and monomorphic
• Antiarrhythmic infusion
No • Expert consultation

• Vagal maneuvers (if regular)

• Adenosine (if regular)
• β-Blocker or calcium channel blocker
• Consider expert consultation
© 2025 American Heart Association
Electrical Cardioversion Algorithm

Tachycardia
With serious signs and symptoms
caused by the tachycardia

If ventricular rate is >150/min, prepare for

immediate cardioversion. May give brief
trial of medications based on specific
arrhythmias. Immediate cardioversion is
generally not needed if heart rate is ≤150/min.

Have available at bedside

• Oxygen saturation monitor
• Suction device
• IV line
• Intubation equipment

Sedate whenever feasible*

Synchronized cardioversion†‡
Atrial fibrillation: 200 J
Atrial flutter: 200 J
Narrow-complex tachycardia: 100 J
Monomorphic VT: 100 J
Polymorphic VT: unsynchronized, high-energy shock (defibrillation)

Notes

*Effective regimens have included a sedative (eg, diazepam) with or without

an analgesic agent (eg, fentanyl). Many experts recommend anesthesia if
service is readily available.
†Note possible need to resynchronize after each cardioversion.
‡If delays in synchronization occur and clinical condition is critical, go
immediately to unsynchronized shocks.

© 2025 American Heart Association

Adult Bradycardia With a Pulse Algorithm

Assess appropriateness for clinical

condition. Heart rate typically
<50/min if bradyarrhythmia.

Cardiopulmonary
compromise?
• Hypotension?
• Acutely altered No
mental status?
• Signs of shock?
• Ischemic chest
discomfort?
• Acute heart
failure?

Yes

Doses/Details
Assessment and support • Identify and treat
• Maintain patent airway and provide oxygen underlying causes Atropine IV dose:
• Assist breathing with positive-pressure – Support ABCs First dose: 1 mg bolus.
ventilation as necessary – Consider oxygen Repeat every 3-5 minutes.
• Attach cardiorespiratory monitor – Obtain 12-lead ECG Maximum total dose: 3 mg.
• Monitor pulse • Observe
Dopamine IV infusion:
Usual infusion rate is
5-20 mcg/kg per minute.
Titrate to patient response;
taper slowly.
Bradycardia No
persists with Epinephrine IV infusion:
cardiopulmonary 2-10 mcg per minute infusion.
compromise? Titrate to patient response.

Possible Causes
Yes
• Myocardial ischemia/
infarction
• Drugs/toxicologic (eg,
Atropine
calcium-channel blockers,
If atropine ineffective: β-blockers, digoxin)
• Transcutaneous pacing • Hypoxia
and/or • Electrolyte abnormality
• Dopamine or (eg, hyperkalemia)
epinephrine infusion

Consider:
• Expert consultation
• Transvenous pacing

© 2025 American Heart Association

Neonatal Resuscitation Algorithm

Antenatal counseling
Team briefing
Equipment check

Birth

Initiate cord management plan

Skin to skin with parent

Term gestation? Yes
Routine care
Good tone?
Maintain normal temperature
Breathing or crying?
Ongoing evaluation
No

Warm and maintain normal temperature

Dry
1 minute

Position
Stimulate and clear airway if needed

No
Apnea or gasping? Labored breathing or
HR <100/min? persistent cyanosis?

Yes Yes

Pulse oximeter
Ventilate
Oxygen if needed
Pulse oximeter
Consider CPAP
Consider cardiac monitor

No Postresuscitation care
HR <100/min? Communicate with family
Team debriefing
Yes

Ventilation corrective steps

Consider intubation or laryngeal mask
Cardiac monitor

Target Oxygen Saturation Table

No
HR <60/min? 2 min 65%-70%

Yes 3 min 70%-75%

Intubate or laryngeal mask 4 min 75%-80%

Chest compressions
5 min 80%-85%
Coordinate 3:1 with ventilation
100% oxygen 10 min 85%-95%
UVC or IO
CPAP indicates continuous positive airway
pressure; HR, heart rate; UVC, umbilical
No venous catheter; and IO, intraosseous
HR <60/min?

Yes

UVC or IO epinephrine every 3-5 minutes

If HR remains <60/min:
• consider hypovolemia
• consider pneumothorax
© 2025 American Heart Association and American Academy of Pediatrics
 Pediatric Basic Life Support Algorithm (1 year of age to puberty)
for Health Care Professionals—Single Rescuer

1
Verify scene safety.

2
• Check for responsiveness.
• Shout for nearby help.
• Activate emergency response system

Normal 3 Abnormal
3b
3a breathing, Look for no breathing breathing,
Support ventilation
Monitor until pulse felt or only gasping and check pulse felt
• Open the airway and reposition
advanced care pulse (simultaneously). • Provide breaths, 1 breath every
arrives. Is pulse definitely felt 2-3 seconds, (20-30 breaths/min)
within 10 seconds? • Asses pulse rate after 2 minutes

4
HR <60/min
Yes with signs of poor No
perfusion despite
oxygenation and
ventilation?
Abnormal
breathing,
pulse not felt 4b
Continue providing
breaths; check pulse
every 2 minutes.

5 5a
Yes • Activate emergency
Witnessed
response system (if not
sudden collapse?
already done)
• Retrieve AED/defibrillator and
No
use immediately.
6
Start CPR
• First rescuer: Perform cycles of
30 compressions and 2 breaths.
• When second rescuer arrives, perform cycles
of 15 compressions and 2 breaths.
• Use AED/defibrillator as soon as it is available.

7
After 2 minutes, if still alone, activate
emergency response system and retrieve
AED/defibrillator (if not already done).

8
Check rhythm.
Shockable rhythm?
Yes, No,
shockable nonshockable
9 10
• Give 1 shock. Resume CPR • Resume CPR immediately for
immediately for 2 minutes (until 2 minutes (until prompted by AED/
prompted by AED/defibrillator to defibrillator to allow rhythm check).
allow rhythm check). • Continue until PALS professionals
• Continue until PALS professionals take over or the child starts to move.
take over or the child starts to move.
© 2025 American Heart Association and American Academy of Pediatrics
 Pediatric Basic Life Support Algorithm (1 year of age to puberty)
for Health Care Professionals—2 or More Rescuers

1
Verify scene safety.

2
• Check for responsiveness.
• Shout for nearby help.
• Activate emergency response system
• Send someone to get AED/
defibrillator

3b
Normal 3 Abnormal
Support ventilation
3a breathing, breathing,
Look for no breathing • Open the airway and reposition
Monitor until pulse felt pulse felt
or only gasping and check • Provide breaths, 1 breath every
advanced care pulse (simultaneously). 2-3 seconds, (20-30 breaths/min)
arrives Is pulse definitely felt • Assess pulse rate after 2 minutes
within 10 seconds?

4
HR <60/min
Yes with signs of poor No
perfusion despite
oxygenation and
Abnormal ventilation?
breathing,
pulse not felt 4a
Continue
providing breaths;
check pulse every
2 minutes.
5
Start CPR
• First rescuer performs cycles of
30 compressions and 2 breaths.
• When second rescuer returns,
perform cycles of 15 compressions
and 2 breaths.
• Use AED/defibrillator as soon as it
is available.

6
Check rhythm.
Rhythm shockable?
Yes, No,
shockable nonshockable
7 8
• Give 1 shock. Resume CPR • Resume CPR immediately for
immediately for 2 minutes (until 2 minutes (until prompted by AED/
prompted by AED/defibrillator to defibrillator to allow rhythm check).
allow rhythm check). • Continue until PALS professionals
• Continue until PALS professionals take over or the child starts to move.
take over or the child starts to move.

© 2025 American Heart Association and American Academy of Pediatrics

Pediatric Cardiac Arrest Algorithm

1
Start CPR High Quality CPR
• Begin bag-mask ventilation and give oxygen • Push hard (≥ 1/3 chest depth)
• Attach monitor/defibrillator • Push fast: 100-120/min
• Allow full chest recoil
• Minimize interruptions in
compressions
Yes Rhythm No • Change compressor every 2 min,
shockable? sooner if fatigued
• If no advanced airway,
compression-ventilation ratio
2 9
– 15:2 - 2 rescuers (pre-puberty)
VF/pVT Asystole/PEA – 30:2 - 2 rescuers (post-puberty
onset)
– 30:2 - 1 rescuer (any age)
• If advanced airway, provide
3 Shock Epinephrine continuous compressions and
ASAP ASAP give a breath every 2-3 seconds
• Monitor ETCO2 and, when
4 10 available, invasive diastolic BP
CPR for 2 min CPR for 2 min Shock Energy for Defibrillation
IV/IO access • IV/IO access
• Epinephrine every 3-5 min • First shock 2 J/kg
• Consider advanced • Second shock 4 J/kg
airway and capnography • Subsequent shocks ≥4 J/kg,
maximum 10 J/kg or adult dose
Rhythm No
shockable? Drug Therapy

Rhythm Yes • Epinephrine IV/IO dose:

Yes 0.01 mg/kg (0.1 mg/mL
shockable? concentration). Max dose 1 mg.
5 Shock • Amiodarone IV/IO dose:
ASAP 5 mg/kg bolus (max 300 mg). May
No repeat up to 3 doses (max 150 mg
6 subsequent doses).
CPR for 2 min 11 or
• Epinephrine every 3-5 min Lidocaine IV/IO dose:
• Consider advanced airway
CPR for 2 min 1 mg/kg
Treat reversible causes
and capnography
Advanced Airway

• Endotracheal intubation or
supraglottic airway
Rhythm No • ETCO2 to confirm and
shockable? monitor ET tube placement
No Rhythm Yes
shockable? Reversible Causes
Yes
• Hypovolemia
7 Shock • Hypoxia
ASAP • Hydrogen ion (acidosis)
• Hypoglycemia
8
• Hypo-/hyperkalemia
CPR for 2 min • Hypothermia
• Amiodarone or lidocaine • Tension pneumothorax
• Treat reversible causes • Tamponade, cardiac
• Toxins
• Thrombosis, pulmonary
• Thrombosis, coronary
12 Go to 5.
• If no signs of return of spontaneous
circulation (ROSC), go to 10
• If ROSC, go to Post–Cardiac Arrest
Care checklist

© 2025 American Heart Association and American Academy of Pediatrics

Pediatric Bradycardia With a Pulse Algorithm

Child with bradycardia and a pulse

Cardiopulmonary
compromise? No
• Acutely altered
mental status
• Signs of shock
• Hypotension

Yes

Assessment and support • Identify and treat

• Maintain patent airway and provide oxygen underlying causes
• Assist breathing with positive-pressure – Support ABCs
ventilation as necessary – Consider oxygen
• Attach cardiorespiratory monitor – Consider 12-lead ECG
• Monitor pulse • Observe

Bradycardia No
persists with
cardiopulmonary
compromise?

Yes

Start CPR if HR <60 No

• IV/IO access
• Epinephrine
• Atropine for increased vagal
tone or primary AV block
Doses/Details

Epinephrine IV/IO dose:

0.01 mg/kg (0.1 mg/mL
• Identify and treat underlying causes concentration. Maximum dose
• Consider transthoracic/transvenous pacing 1 mg).
Atropine IV/IO dose:
0.02 mg/kg. May repeat once.
Minimum dose 0.1 mg and
maximum single dose 0.5 mg.
Yes Check pulse
every 2 minutes. Possible Causes
Pulse present?
• Hypothermia
• Hypoxia
No
• Toxins/medications
• Increased intracranial
Go to Pediatric pressure
Cardiac Arrest Algorithm. • Increased vagal tone
• Heart block
• Physiologic/appropriate
© 2025 American Heart Association and American Academy of Pediatrics
Pediatric Tachyarrhythmia With a Pulse Algorithm

Probable Supraventricular
Child with suspected tachyarrythmia
Tachycardia

• P waves absent/abnormal
• RR interval not variable
• Infant rate usually ≥220/min
Initial assessment and support • Child rate usually ≥180/min
• Maintain patent airway • History of abrupt rate change
• Assist breathing with positive-pressure
ventilation and oxygen as necessary Doses/Details
• Attach cardiorespiratory monitor
Synchronized cardioversion
• IV/IO access
Begin with 0.5-1 J/kg; if not
• 12-Lead ECG if available effective, increase to 2 J/kg.
Sedate if needed, but don’t delay
cardioversion.
Probable sinus
tachycardia if Adenosine IV/IO dose:
• P waves present/normal Evaluate 0.1 mg/kg (max 6 mg) rapid push
• Variable RR interval rhythm. followed by IV flush
• Infant rate usually <220/min Consider repeat dose 0.2 mg/kg
• Child rate usually <180/min rapid push followed by IV flush;
maximum dose, 12 mg

Search for
and treat cause. Cardiopulmonary
compromise?
Yes • Acutely altered No
mental status
• Signs of shock
• Hypotension

Narrow Wide Narrow Wide

(≤0.09 sec) (>0.09 sec) (≤0.09 sec) (>0.09 sec)
Evaluate Evaluate
QRS duration. QRS duration.

Probable Possible ventricular Probable Possible ventricular

supraventricular tachycardia supraventricular tachycardia or
tachycardia tachycardia supraventricular
tachycardia with
aberrancy

• If IV/IO access is present, Synchronized

give adenosine cardioversion Consider If rhythm is regular and
or Expert consultation vagal maneuvers. QRS monomorphic,
• Perform synchronized is advised before consider adenosine.
cardioversion additional drug
therapies.

Give IV/IO Expert consultation

adenosine. is recommended.
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