Signs of Cardiac Arrest in Children
The signs of cardiac arrest in children are: unresponsiveness, no pulse felt, and agonal gasps 1.
Key Clinical Indicators
According to the 2025 AHA/AAP Guidelines, cardiac arrest in children is identified by the absence of "signs of life" 1. The specific signs that indicate cardiac arrest include:
Signs Present in Cardiac Arrest:
- Unresponsiveness - The child does not respond to stimulation
- No pulse felt - Absence of palpable central pulse (though pulse checks are unreliable and should not delay CPR)
- Agonal gasps - Irregular, gasping respirations that are NOT normal breathing
Signs NOT Present in Cardiac Arrest:
- Responsiveness - This would indicate the child is NOT in cardiac arrest
- Pulse felt - Presence of a pulse indicates the child is NOT in cardiac arrest
- Normal breathing - Regular, effective breathing indicates the child is NOT in cardiac arrest
Critical Clinical Context
The 2025 guidelines emphasize that lay rescuers should not delay CPR in any child without "signs of life" 1. This is crucial because:
- Pulse palpation is highly unreliable - lay rescuers have only 47% accuracy at 5 seconds and 73% at 10 seconds 1
- Even healthcare professionals demonstrate only 78% accuracy in pulse detection 1
- Harmful delays occur when rescuers attempt pulse checks 1
Important Distinction: Agonal Gasps vs. Normal Breathing
Agonal gasps are a sign of cardiac arrest, not effective breathing. These irregular, gasping respirations should prompt immediate CPR initiation 1. In contrast, normal breathing indicates the child is not in cardiac arrest.
Clinical Pitfall to Avoid
Do not confuse agonal gasps with normal breathing - this is a common error that delays life-saving CPR. If a child is unresponsive and not breathing normally (including if they have only agonal gasps), start CPR immediately 1.