Out of hospital protocol
Collapsed unresponsive patient 
5 cycles (2 minutes) of CPR then call 911 if alone; get someone else to call 911 immediately, if possible. The exception is sudden, unexplained collapse (more likely to be cardiac arrhythmia); Phone 911, Get AED and then start CPR.
Airway
- Open airway, give second attempt if initial attempt unsuccessful.
- No Trauma: Head tilt/Chin lift
- Trauma: Jaw thrust with inline C-spine immobilization
Breathing; Initial
Confirm patient isn't breathing; then give 2 breaths at 1 second/breath [look for chest rise]. If no chest rise; reposition airway and attempt again. If airway obstructed; perform Heimlich maneuver (subdiaphragmatic abdominal thrusts) until the object is expelled or the child becomes unconscious. If unconsciousness occurs, look in the mouth to see if object present, then attempt breath, reposition if breath doesn't go in and reattempt. Follow attempts at ventilation with chest compressions and then continue with breaths after looking in mouth for object.
Breathing (Rescue breathing, no CPR)
12-20 breaths per minute (only if definite pulse >60 BPM, otherwise provide chest compressions). Pulse check every 2 minutes.
Breathing; CPR ongoing [No advanced airway]
- Single Rescuer: 2 breaths then 30 compressions
- Two Rescuers: 2 breaths then 15 compressions
- Compressions paused for breaths
Breathing; CPR ongoing [Advanced airway]
100 compressions/min with 8-10 breaths/minute with no pauses for breaths
Circulation; Pulse check
- Site: Carotid or femoral
- Duration: 10 seconds (30-45 seconds if hypothermia)
Circulation; Chest compressions
Rate/Ratio: 30 compressions then 2 breaths at rate of 100/minute (if advanced airway then 100 compressions/minute with no pauses for breaths)
Compression technique
Compress at lower half of sternum using the heel of 1 hand or using 2 hands with heel of 1 hand with second on top. Depth of compressions to be 1/3 to 1/2 of the depth of the chest or approximately 1-1.5 inches.
Ratio Compressions:Ventilations
- Basic Airway:
- 30:2 single rescuer
- 15:2 for 2 rescuers
- Advanced airway:
- Give compressions at 100/minute and give a breath every 6-8 seconds (8-10 breaths/minute).
Defibrillation; AED
Provide CPR until AED is connected. Cease CPR when device ready to analyze rhythm. Have AED analyze rhythm.
- Shock Advised: Device will deliver single shock. Continue CPR.
- No Shock Advised: Continue CPR.
- Every 5 cycles (2 minutes) have AED reanalyze rhythm and deliver or not deliver shock; resume CPR. Continue until EMS/Other personal assume care.
- Cease compressions if victim becomes conscious or pulse returns.
Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.