The correct answer is:

If the boy is in cardiorespiratory arrest and an advanced airway has been placed, ventilations should be delivered asynchronously to chest compressions at 1 breath per 2-3 seconds (changed from previous guidelines, which recommended 1 breath per 6 seconds for intubated pediatric patients in cardiac arrest).

Key Point:

The 2020 PALS guidelines changed the recommended ventilation rate after intubation of pediatric patients in either cardiorespiratory or pure respiratory arrest from 1 breath every 6 seconds (2010 guidelines, unchanged for 2015) to 1 breath every 2 to 3 seconds (new 2020 guidelines). Adult post-intubation ventilation rates (1 every 6 seconds) have not changed since the 2010 guidelines.

Explanation:

In the 2020 Adult and Pediatric Advanced Life Support guidelines, several airway/ventilation changes are introduced. Below is a list of all pertinent 2020 ventilation guidelines (both changed and unchanged recommendations).

1.       New - Pediatric pre-intubation ventilation: 1 ventilation per 2-3 seconds should be delivered if pulse is present (changed from 1 breath per 6 seconds) and 30 compressions to 2 ventilations for single rescuer or 15 compressions to 2 ventilations for 2 rescuers if pulse is absent (unchanged)

2.       New - Pediatric post-intubation ventilation: once an advanced airway is in place, 1 ventilation per 2-3 seconds is given regardless of present/absent pulse (changed from 1 ventilation per 6 seconds). If compressions are being given, ventilation is asynchronous to compressions (unchanged).

3.       No Change - Adult pre-intubation ventilation: 1 ventilation per 6 seconds should be delivered if pulse present (unchanged) and 30 compressions to 2 ventilations should be delivered if pulse is absent (unchanged)

4.       No Change - Adult post-intubation ventilation: once an advanced airway is in place, 1 ventilation per 6 seconds regardless of present/absent pulse (unchanged). If compressions are being given, ventilation is asynchronous to compressions (unchanged).

5.       No Change - Neonatal ventilation: if the protocol calls for ventilations, deliver 30 ventilations per minute (2 ventilations per second)

Other pertinent PALS changes for 2020 are:

1.       Skip Cricoid pressure: in adult or pediatric patients in cardiac arrest, this time-honored maneuver is no longer recommended in adults or children because it lowers intubation success without reducing regurgitation risk. In adult patients NOT in cardiac arrest, cricoid pressure during bag-valve-mask ventilation may protect against stomach insufflation and regurgitation/aspiration However, in pediatric patients with a pulse who require intubation, cricoid pressure during induction and intubation decreases success rate without reducing regurgitation (2018 study).

2.       Grab Pediatric Cuffed Endotracheal Tubes: It is reasonable to choose cuffed endotracheal tubes (ETTs) instead of uncuffed ETTs for pediatric intubations because cuffed ETTs lead to fewer ETT replacement episodes during the subsequent care.

3.       Give Epinephrine Early: In both adult and pediatric cardiac arrest, the epinephrine protocol has not changed per se, but emphasis has been added that giving epinephrine earlier rather than later increases survival. The 2020 guidelines suggest giving the first epinephrine dose within 5 minutes of initiating compressions in adult and pediatric patients with ongoing cardiac arrest and a shockable rhythm. They suggest that the first epinephrine dose is given within 5 minutes of the cardiac arrest onset for non-shockable rhythms.

4.       Initiate Post-Arrest EEG Monitoring in Survivors: in patients with return of spontaneous circulation (ROSC) after cardiac arrest, EEG monitoring should be initiated when available because post-arrest seizures are very common and are often non-detectable. 

5.       Discontinue Futile Neonatal Resuscitation: In neonates, resuscitation efforts may be discontinued after 20 minutes of effectively completing all steps of neonatal resuscitation.

Reference:

Merchant RM, Topjian AA, et al. Part 1: Executive Summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Oct 2020

Panchal AR, Bartos JA, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Oct 2020

Topijan A, Raymond TT, et al. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Oct 2020

Aziz K, Lee HC, et al. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Oct 2020

Kojima T, Harwayne-Gidansky I, et al; National Emergency Airway
Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and
Sepsis Investigators (PALISI). Cricoid Pressure During Induction for Tracheal 
 intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children. Pediatr Crit Care Med. 2018;19:528–537. doi: 10.1097/PCC.0000000000001531