Cardiac Arrest Algorithm

Shout for Help / Active Emergency Response

Doses/ Details
1
Start CPR CPR Quality
• Push hard (≥ 2 inches *5 cm+) and fast (≥
• Give oxygen 100/min) and allow complete chest recoil
• Attach monitor / defibrillator • Minimize interruption in compressions
• Avoid excessive ventilation
• Rotate compressor every 2 minutes
• If no advance airway, 30:2 compression-
Yes No ventilation ratio
Rhythm schockable?
2 • Quantitative waveform capnography
- If PETCO2 <10 mm Hg, attempt to
9 improve CPR quality
VF/VT Asystole/PEA • Intra-arterial pressure
- If relaxation phase (diastolic) pressure
3 Shock <20 mm Hg, attempt to improve CPR
4 quality
CPR 2 min Return of Spontaneous CirculatIon (ROSC)
• IV/IO access • Pulse and blood pressure
• Abrupt sustained increase in PETCO2
(typically ≥40 mm Hg)
No • Spontaneous arterial pressure waves
Rhythm schockable? with intra-arterial monitoring
Shock Energy
Yes Shock • Biphasic: Manufacturer recommendation
5 10 (120-200 J); if unknown, use maximum
6 available.
CPR 2 min Second and subsequent doses should be
CPR 2 min
• IV/IO access equivalent, and higher doses may be
• Epinephrine every 3-5 min considered.
• Epinephrine every 3-5 min
• Consider advance airway, • Monophasic : 360 J
• Consider advance airway,
capnography
capnography
Drug Therapy
• Epinephrine IV/IO Dose:
1 mg every 3-5 minutes
No Yes • Vasopressin IV/IO Dose:
Rhythm schockable? Rhythm schockable? 40 units can replace first or second dose
of epinephrine
• Amiodarone IV/IO Dose:
Yes First dose: 300 mg bolus.
Shock Second dose: 150 mg.
7 No
Advance Airway
• Supraglottic advanced airway or
8 11 endotracheal intubation
CPR 2 min • Waveform capnography to confirm and
CPR 2 min monitor ET tube placement
• Amiodarone • Treat reversible causes • 8-10 breaths per minute with continuous
•Treat reversible causes chest compression

No Yes Reversible Causes:

₋ Hypovolemia
Rhythm schockable? ₋ Hypoxia
₋ Hydrogen ion (acidosis)
12 ₋ Hypo-/Hyperkalemia
₋ Hypothermia
• If no sign of return of spontaneous circulation Go to ₋ Tension pneumothorax
₋ Tamponade, cardiac
(ROSC), go to 10 or 11 5 or 7 ₋ Toxins
• If ROSC, go to Post – Cardiac Arrest Care ₋ Thrombosis, pulmonary
₋ Thrombosis, coronary

Reference by: 2010 Handbook of Emergency Cardiovascular Care for Healthcare providers