When do I switch from NRP to PALS guidelines?
There is little evidence to say when it is better to use PALs vs NRP. The two approaches differ in approach and we believe that the most important thing to consider is the likely etiology of collapse once you are out of the DR environment. If it is likely a respiratory etiology, then NRP with its primary focus on effective ventilation is appropriate. If the etiology is more likely arrhythmia (cardiac in origin)-a common cause within the CV-ICU, then PALs is appropriate.
Thus an arrest in a 50 day old 24 week gestation infant with chronic lung disease is most likely respiratory in origin, and the approach of NRP makes sense for initial approach. A 14 day old with complex congenital heart disease might best be approached by assuming an underlying cardiac etiology, and PALS would be more appropriate.