Adult Cardiac Arrest Circular Algorithm

First, shout for Help/Activate Emergency Response

Then Start CPR
     • Give oxygen
     • Attach monitor/defibrillator

Then start cycle 1, with 2 minutes per cycle

If VF/VT Shock

Continuous CPR

Monitor CPR quality

Continuous CPR

After 2 minutes Check Rhythm again

If Return of Spontaneous Circulation occurs (ROSC)

Otherwise, if VF/VT Shock and repeat cycle

Meanwhile consider the following:

Drug Therapy
IV/IO access
Epinephrine every 3-5 minutes
Amiodarone for refractory VF/VT

Consider Advanced Airway
Quantitative waveform capnography

Treat Reversible Causes

Additional Info

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 (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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