Cardiac Arrest

Circular Algorithm

Shout for Help/Activate Emergency Response

START CPR
Give Oxygen Attach Monitor/Defibrillator
2 minutes Return of Spontaneous
Circulation (ROSC)
Check Post-Cardiac
Rhythm Arrest Care
If VF/ VT
Shock
Drug Therapy
IV/IO access
Epinephrine every 3-5 minutes
Amiodarone for refractory VF / VT

Consider Advanced Airway

Quantitative waveform capnography

Treat Reversible Causes

Doses/Details for the Cardiac Arrest Algorithms

CPR Quality Return of Spontaneous
Push hard ( 2 inches [5cm]) and fast ( 100/min) and allow Circulation (ROSC)
complete chest recoil.
Minimize interruptions in compressions.* Pulse and blood pressure
Avoid excessive ventilation Abrupt sustained increase in PETCO (typically
2

Rotate compressor every 2 minutes 40 mm Hg)

If no advanced airway, 30:2 compression-ventilation ratio Spontaneous arterial pressure waves with intra-arterial
Quantitative waveform capnography monitoring
If PETCO 10mm Hg, attempt to improve CPR quality
2

Intra-arterial pressure
If relaxation phase (diastolic) pressure
20 mm Hg, attempt to improve CPR quality.
Shock Energy
Biphasic: Manufacturer recommendation (eg, initial dose of
Drug Therapy 120-200 J): if unknown, use maximum available.
Second and subsequent doses should be equivalent, and
Epinephrine IV/IO Dose: 1 mg every 3-5 minutes higher doses may be considered
Vasopressin IV/IO Dose: 40 units can replace first or Monophasic: 360 J
second dose of epinephrine
Amiodarone IV/IO Dose**:First dose: 300 mg bolus.
second dose: 150 mg
Reversible Causes
Advanced Airway*** - Hypovolemia - Tension pneumothorax
- Hypoxia - Tamponade, cardiac
Supraglottic advanced airway or endotracheal intubation
Waveform capnography to confirm and monitor ET tube - Hydrogen ion (acidosis) - Toxins
placement - Hypo-/Hyperkalemia - Thrombosis, pulmonary
8-10 breaths per minute with continuous chest compressions - Hypothermia - Thrombosis, coronary

*Bobrow BJ, Clark LL, Ewy GA, Chikani V, Sanders AB, Berg RA, Richman PB Minimally interrupted cardiac resuscitation by emergency medical
services for out of hospital cardiac arrest. JAMA 2008;299:1158-1165
**Dorian P, Cass D, Schwartz B, Cooper R. Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock resistant ventricular
fibrillation N Engl J Med 2002;346:884-890.
***Dorges V, Wenzel V, Knacke P, Gerlach K, Comparison of different airway management strategies to ventilate apneic, nonpreoxygenated
patients. Crit Care Med. 2003;31:800-804

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 Cardiac Arrest
Algorithm

Shout for Help/Activate Emergency Response

Start CP
.R
Give Oxygen
1 Attach Monitor/Defibrillator

Y Rhythm Shockable? N

2 VF/VT Asystole/PEA 9
YES

3 Shock* CPR 2 min

IV/IO access
CPR 2 min
IV/IO access 4 10 Epinephrine every 3-5 min
Consider advanced airway,
capnography

Rhythm Shockable? N
NO
Y

Rhythm Shockable? Y
5 Shock
N

CPR 2 min CPR 2 min

Epinephrine every 3-5 min 6 11 Treat reversible causes
Consider advanced airway,
capnography 12
If no signs of return of
Rhythm Shockable? N spontaneous circulation N Rhythm Shockable?
(ROSC), go to 10 or 11.
Y Y

7 Shock NO

If ROSC, go to Post-
CPR 2 min Cardiac Arrest Care.
Amiodarone
Treat reversible causes
8 Go to 5 or 7

YES

* Link MS, Atkins DL, Passman RS, Halperin HR, Samson RA, White RD, Cudnik MT, Berg MD, Kudenchuk PJ, Kerber RE. “Part 6: electrical therapies: automated
external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care”. Circulation. 2010;122(suppl 3): S706-S719. http://circ.ahajournals.org/content/122/18_suppl_3/S706

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Complete your ACLS recertification online with the highest quality courses at http://www.acls.net and use promo code PDF2014 during checkout for 15% off.