At what heart rate should high-quality CPR be initiated for pediatric symptomatic bradycardia?

High-quality CPR for pediatric patients experiencing symptomatic bradycardia should be initiated when the heart rate falls below 60 beats per minute (BPM). This threshold is crucial because bradycardia in children can lead to inadequate perfusion and oxygen delivery to vital organs, potentially resulting in severe complications if not addressed promptly.

The rationale for starting CPR at this heart rate aligns with pediatric guidelines indicating that a heart rate below 60 BPM in infants and children, especially when accompanied by signs of poor perfusion or altered mental status, warrants immediate intervention. This is part of a broader recognition that aggressive measures are crucial in a pediatric emergency setting to stabilize the patient's condition and prevent further deterioration.

In contrast, heart rates above this threshold may not indicate a significant compromise in cardiac output that would necessitate the same urgent response. Each of the other options represents heart rates that, while they may still be concerning, do not trigger the same immediate need for high-quality CPR in the pediatric population. Therefore, initiating CPR at heart rates less than 60 BPM reflects the evidence-based approach to managing symptomatic bradycardia in children effectively.