For pediatric VSAs, at what heart rate do we initiate compressions?
Per the AHA guidelines, if you do not feel a pulse and you believe the patient to be VSA in Pulseless Electrical Activity (PEA), there is no minimum heart rate before you should initiate compressions.
However, in non-arrested pediatric patients: Bradycardia associated with hemodynamic compromise, even with a palpable pulse, may be a harbinger for cardiac arrest. As such, bradycardia with a heart rate of less than 60 beats per minute requires emergent evaluation for cardiopulmonary compromise. If cardiopulmonary compromise is present (signs of poor perfusion manifested by altered level of consciousness, pallor, cyanosis etc.), the initial management in the pediatric patient requires simultaneous assessment of the etiology and treatment by supporting airway, ventilation, and oxygenation. If bradycardia with cardiopulmonary compromise is present despite effective oxygenation and ventilation, CPR should be initiated immediately.
Please note that these pediatric guidelines apply to children approximately 1 year of age until puberty (where puberty is defined as breast development in females and the presence of axillary hair in males).