V

Figuro 49. Adult Cardiac Arrest Algorithm, asystole/PEA pathway.

© Start CPR CPR Quality

• Give oxygen • Push hard (at least 5 cm) and

• Attach monitor/defibrillator -
fast (100 120/min) and allow
complete chest recoil.
• Minimize interruptions in
compressions.
No • Avoid excessive ventilation
Yes Rhythm • Change compressor every
shockable? 2 minutes, or sooner if fatigued
( .
• If no advanced airway 30:2
compression-ventilation ratio
© VF/pVT
9
Asystole/ PEA ) • Quantitative waveform
capnography
- If PETCO,is low or decreasing ,

reassess CPR quality.

Epinephrine Shock Energy for Defibrlllatlon

Shock
ASAP • Biphasic: Manufacturer
4
.
recommendation (eg initial
dose of 120-200 J):if unknown,
CPR 2 min
CPR 2 min use maximum available.
• IV/IO access
• IV/IO access Second and subsequent doses
• Epinephrine every 3-5 min should be equivalent, and higher
• Consider advanced airway, doses may be considered.
1 r capnography • Monophasic: 360 J

No Drug Therapy
Rhythm
+ - shockable? ' r
• Epinephrine IV / IO dose:
Rhythm Yes 1 mg every 3-5 minutes
J Yes shockable? • Amiodarone IV/IO dose:

.
First dose:300 mg bolus.

©f Shock
No
Second dose: 150 mg.
or
Lidocaine IV/IO dose:
n -
First dose: 1 1.5 mg/kg.
Second dose: 0.5-0.75 mg/kg.
CPR 2 min
• Epinephrine every 3- 5 min Advanced Airway
• Consider advanced airway,
capnography • Endotracheal intubation or su-
praglottic advanced airway
• Waveform capnography or cap-
t nometry to confirm and monitor
' ET tube placement
Rhythm No
• Once advanced airway in place,
shockable? give 1 breath every 6 seconds
(10 breaths /min) with continu-
| Yes ous chest compressions
Return of Spontaneous
Shock Circulation (ROSC)
7\ •
© CPR 2 min
© CPR 2 min
•
Pulse and blood pressure
Abrupt sustained increase in
PETCOj (typically 240 mm Hg)
Spontaneous arterial pressure
• Amiodarone or lidocaine •
• Treat reversible causes • Treat reversible causes waves with intra -arterial
^ monitoring

Reversible Causes
Rhythm \ Yes
> • Hypovolemia
Xshockable? / • Hypoxia
^ • Hydrogen ion (acidosis)
• 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, goto • Thrombosis, pulmonary
Post-Cardiac Arrest Care • Thrombosis, coronary
• Consider appropriateness
of continued resuscitation
O 2020 American Heart Association
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134