Pediatric Post ROSC Rate (Bradycardia): What is the first step if the heart rate is less than 60 beats per minute?

• A. Provide Oxygenation and Ventilation if HR < 60
• B. Begin CPR immediately
• C. Administer Epinephrine 0.01 mg/kg
• D. Initiate defibrillation

Answer: (A)

The first step is to ensure adequate oxygenation and ventilation. In pediatric patients who have ROSC but are bradycardic (HR < 60), this often reflects hypoxia or inadequate perfusion. Providing airway support and improving ventilation to optimize oxygen delivery to the heart and brain can reverse the bradycardia without invasive measures. Secure the airway, assess breathing, and adjust ventilation to achieve good oxygenation. If bradycardia and signs of poor perfusion persist after ventilation is optimized, then escalate to additional interventions such as epinephrine or CPR as indicated. Defibrillation isn’t used for bradycardia with a pulse; it’s reserved for shockable, pulseless rhythms.