Adult Cardiac Arrest Algorithm

Step 1:
Shout for Help/Activate Emergency Response
Start CPR
     • Give oxygen
     • Attach monitor/defibrillator

Rhythm shockable?
Yes
No

Step 2:
VF/VT

Step 3:
Shock

Step 4:
CPR 2 min
     • IV/IO access
Rhythm shockable?

Step 5:
Shock

Step 6:
CPR 2 min
     • Epinephrine every 3-5 min
     • Consider advanced airway, capnography
Rhythm shockable?

Step 7:
Shock

Step 8:
CPR 2 min
     • Amiodarone
     • Treat reversible causes

Step 9:
Asystole/PEA

Step 10:
CPR 2 min
     • IV/IO access
     • Epinephrine every 3-5 min
     •Consider advanced airway, capnography
Rhythm shockable?

Step 11:
CPR 2 min
     • Treat reversible causes
Rhythm shockable?

Step 12:
     • If no signs of return of spontaneous circulation (ROSC), go to 10 or 11
     • If ROSC, go to Post-Cardiac Arrest Care
Go to 5 or 7

CPR Quality
     • Push hard (≥2 inches [5 cm]) and fast (≥100/min) and allow complete chest recoil
     • Minimize interruptions in compressions
     • Avoid excessive ventilation
     • Rotate compressor every 2 minutes
     • If no advanced airway, 30:2 compression-ventilation ratio
     • Quantitative waveform capnography
        o If PETCO2 <10mm Hg, attempt to improve CPR quality
     • Intra-arterial pressure
        o If relaxation phase (diastolic) pressure <20 mm Hg, attempt to improve CPR quality

Return of Spontaneous Circulation (ROSC)
     • Pulse and blood pressure
     • Abrupt sustained increase in PETCO2 (typically ≥40 mm Hg)
     • Spontaneous arterial pressure waves with intra-arterial monitoring

Shock Energy
     • Biphasic: Manufacturer recommendation (eg, initial dose of 120-200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent, and higher doses may be considered.
     • Monophasic: 360 J

Drug Therapy
     • Epinephrine IV/IO Dose:    
1 mg every 3-5 minutes
     • Vasopressin IV/IO Dose:
40 units can replace first or second dose of epinephrine
     • Amiodarone IV/IO Dose:
First dose: 300 mg bolus.
Second dose: 150 mg.

Advanced Airway
     • Supraglottic advanced airway or endotracheal intubation
     • Waveform capnography to confirm and monitor ET tube placement
     • 8-10 breaths per minute with continuous chest compressions

Reversible causes
     • Hypovolemia
     • Hypoxia
     • Hydrogen ion (acidosis)
     • Hypo-/hyperkalemia
     • Hypothermia
     • Tension pneumothorax
     • Tamponade, cardiac
     • Toxins
     • Thrombosis, pulmonary
     • Thrombosis, coronary

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