Adult Cardiac Arrest Algorithm (VF/pVT/Asystole/PEA)

1
CPR Quality
Start CPR
• Give oxygen • Push hard (at least 2 inches
• Attach monitor/defibrillator [5 cm]) and fast (100-120/min)
and allow complete chest recoil.
• Minimize interruptions in
compressions.
Yes No • Avoid excessive ventilation.
Rhythm • Change compressor every
shockable? 2 minutes, or sooner if fatigued.
• If no advanced airway, 30:2
2 9 compression-ventilation ratio.
VF/pVT Asystole/PEA • Quantitative waveform
capnography
– If Petco2 is low or decreasing,
reassess CPR quality.
3 Shock Epinephrine Shock Energy for Defibrillation
ASAP
• Biphasic: Manufacturer
4 10 recommendation (eg, initial
dose of 120-200 J); if unknown,
CPR 2 min CPR 2 min use maximum available.
• IV/IO access Second and subsequent doses
• IV/IO access
• Epinephrine every 3-5 min should be equivalent, and higher
• Consider advanced airway, doses may be considered.
capnography • Monophasic: 360 J

Rhythm No Drug Therapy

shockable? • Epinephrine IV/IO dose:
Rhythm Yes 1 mg every 3-5 minutes
Yes • Amiodarone IV/IO dose:
shockable?
First dose: 300 mg bolus.
5 Shock Second dose: 150 mg.
or
No Lidocaine IV/IO dose:
6 First dose: 1-1.5 mg/kg.
CPR 2 min Second dose: 0.5-0.75 mg/kg.
• Epinephrine every 3-5 min
Advanced Airway
• Consider advanced airway,
capnography • Endotracheal intubation or su-
praglottic advanced airway
• Waveform capnography or cap-
nometry to confirm and monitor
Rhythm No ET tube placement
• Once advanced airway in place,
shockable? give 1 breath every 6 seconds
(10 breaths/min) with continu-
Yes ous chest compressions

7 Shock Return of Spontaneous

Circulation (ROSC)

8 • Pulse and blood pressure

11
• Abrupt sustained increase in
CPR 2 min CPR 2 min Petco2 (typically ≥40 mm Hg)
• Amiodarone or lidocaine • Spontaneous arterial pressure
• Treat reversible causes
• Treat reversible causes waves with intra-arterial
monitoring

Reversible Causes
No Rhythm Yes
• Hypovolemia
shockable? • Hypoxia
• Hydrogen ion (acidosis)
12 • Hypo-/hyperkalemia
• Hypothermia
• If no signs of return of Go to 5 or 7 • Tension pneumothorax
spontaneous circulation • Tamponade, cardiac
(ROSC), go to 10 or 11 • Toxins
• If ROSC, go to • Thrombosis, pulmonary
• Thrombosis, coronary
Post–Cardiac Arrest Care
• Consider appropriateness
of continued resuscitation
© 2020 American Heart Association