Adult Basic Life Su ort Algorithm for Healthcare Providers

Verify scene safety.

• Check for responsiveness.

• Shout for nearby help.
• Activate emergency response
system via mobile device
(if appropriate).
• Get AED and emergency equipment
(or send someone to do so).

Normal No normal • Provide rescue breathing,

breathing, breathing, 1 breath every 6 seconds or
Look for no breathing
pulse felt pulse felt 10 breaths/min.
Monitor until or only gasping and check
• Check pulse every 2 minutes;
emergency pulse (simultaneously).
if no pulse, start CPR.
responders arrive. Is pulse definitely felt
• If possible opioid overdose,
within 10 seconds?
administer naloxone if
available per protocol.

No breathing
or only gasping,
pulse not felt

By this time in all scenarios, emergency

response system or backup is activated,
and AED and emergency equipment are
retrieved or someone is retrieving them.
Start CPR
• Perform cycles of 30 compressions
and 2 breaths.
• Use AED as soon as it is available.

AED arrives.

Check rhythm.
Shockable rhythm?
Yes, No,
shockable nonshockable

• Give 1 shock. Resume CPR • Resume CPR immediately for

immediately for 2 minutes 2 minutes (until prompted by AED
(until prompted by AED to allow to allow rhythm check).
rhythm check). • Continue until ALS providers take
• Continue until ALS providers take over or victim starts to move.
over or victim starts to move.

© 2020 American Heart Association

Basic Life Support
Adult CPR and AED
Skills Testing Critical Skills Descriptors

Assesses victim and activates emergency response system (this must precede starting compressions)
within 30 seconds. After determining that the scene is safe:
Checks for responsiveness by tapping and shouting
Shouts for help/directs someone to call for help and get AED/defibrillator
Checks for no breathing or no normal breathing (only gasping)
– Scans from the head to the chest for a minimum of 5 seconds and no more than 10 seconds
Checks carotid pulse
– Should be done simultaneously with check for breathing
– Checks for a minimum of 5 seconds and no more than 10 seconds
Performs high-quality chest compressions (initiates compressions immediately after recognition of
cardiac arrest)
Correct hand placement
– Lower half of sternum
– 2-handed (second hand on top of the first or grasping the wrist of the first hand)
Compression rate of 100 to 120/min
– Delivers 30 compressions in 15 to 18 seconds
Compression depth and recoil—at least 2 inches (5 cm) and avoid compressing more than 2.4 inches (6 cm)
– Use of a commercial feedback device or high-fidelity manikin is required
– Complete chest recoil after each compression
Minimizes interruptions in compressions
– Delivers 2 breaths so less than 10 seconds elapses between last compression of one cycle and first
compression of next cycle
– Compressions resumed immediately after shock/no shock indicated
Provides 2 breaths by using a barrier device
Opens airway adequately
– Uses a head tilt–chin lift maneuver or jaw thrust
Delivers each breath over 1 second
Delivers breaths that produce visible chest rise
Avoids excessive ventilation
Resumes chest compressions in less than 10 seconds
Performs same steps for compressions and breaths for Cycle 2
AED use
Powers on AED
– Turns AED on by pushing button or lifting lid as soon as it arrives
Correctly attaches pads
– Places proper-sized (adult) pads for victim’s age in correct location
Clears for analysis
– Clears rescuers from victim for AED to analyze rhythm (pushes analyze button if required by device)
– Communicates clearly to all other rescuers to stop touching victim
Clears to safely deliver shock
– Communicates clearly to all other rescuers to stop touching victim
Safely delivers a shock
– Resumes chest compressions immediately after shock delivery
– Does not turn off AED during CPR
Resumes compressions
Ensures that high-quality chest compressions are resumed immediately after shock delivery
– Performs same steps for compressions
© 2020 American Heart Association
Adult Cardiac Arrest Algorithm

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
ASAP Shock Energy for Defibrillation

4 10 • Biphasic: Manufacturer
recommendation (eg, initial
CPR 2 min CPR 2 min dose of 120-200 J); if unknown,
• IV/IO access
spinibrine
• IV/IO access use maximum available.
min • Epinephrine every 3-5 min Second and subsequent doses
I my/2-3 • Consider advanced airway, should be equivalent, and higher
capnography doses may be considered.
• Monophasic: 360 J
Rhythm No
shockable? Drug Therapy

Rhythm Yes • Epinephrine IV/IO dose:

Yes 1 mg every 3-5 minutes
shockable?
• Amiodarone IV/IO dose:
5 Shock First dose: 300 mg bolus.
Second dose: 150 mg.
No or
6 Lidocaine IV/IO dose:
CPR 2 min First dose: 1-1.5 mg/kg.
• Epinephrine every 3-5 min Second dose: 0.5-0.75 mg/kg.
• Consider advanced airway, Advanced Airway
capnography
• Endotracheal intubation or su-
praglottic advanced airway
• Waveform capnography or cap-
Rhythm No nometry to confirm and monitor
ET tube placement
shockable? • Once advanced airway in place,
give 1 breath every 6 seconds
Yes (10 breaths/min) with continu-
ous chest compressions
7 Shock
Return of Spontaneous
Circulation (ROSC)
8 11
• Pulse and blood pressure
CPR 2 min CPR 2 min • Abrupt sustained increase in
• Amiodarone or lidocaine Petco2 (typically ≥40 mm Hg)
• Treat reversible causes
• Treat reversible causes • Spontaneous arterial pressure
waves with intra-arterial
monitoring

No Rhythm Yes Reversible Causes

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