Panchal et al Adult Basic and Advanced Life Support: 2020 AHA Guidelines for CPR and ECC

Text in cascading boxes describes the actions that a provider should perform in sequence during
an adult cardiac arrest. Arrows guide providers from one box to the next as they perform the
actions. Some boxes have 2 arrows that lead outward, each to a different box depending on
the outcome of the most recent action taken. Pathways are linked.
Box 1
Verify scene safety.
Box 2
Check for responsiveness.
Shout for nearby help.
Activate the emergency response system via mobile device (if appropriate).
Get an AED and emergency equipment (or send someone to do so).
Box 3
Look for no breathing or only gasping and check pulse (simultaneously).
Is a pulse definitely felt within 10 seconds?
If the person is breathing normally and has a pulse, proceed to Box 3a.
If the person is not breathing normally but has a pulse, proceed to Box 3b.
If the person is not breathing or is only gasping and no pulse is felt, proceed to Box 4.
Box 3a
Monitor the person until emergency responders arrive.
Box 3b
Provide rescue breathing, 1 breath every 6 seconds or 10 breaths per minute.
Check pulse every 2 minutes; if no pulse, start CPR.
If it is a possible opioid overdose, administer naloxone if available per protocol.
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.
Box 4
Start CPR
• Perform
cycles of 30 compressions and 2 breaths.
• Use the
AED as soon as it is available.
Box 5
The AED arrives.
Box 6
The AED checks the rhythm. Is the rhythm shockable?
If Yes, the rhythm is shockable, proceed to Box 7.
If No, the rhythm is nonshockable, proceed to Box 8.
Box 7
• Give 1
shock. Resume CPR immediately for 2 minutes (until prompted by the AED to allow rhythm
check).
• Continue
until advanced life support providers take over or the victim starts to move.
Box 8
• Resume
CPR immediately for 2 minutes (until prompted by the AED to allow rhythm check).
• Continue
until advanced life support providers take over or the victim starts to move.
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Figure 2. Adult BLS Algorithm for Healthcare Providers.

AED indicates automated external defibrillator; ALS, advanced life support; BLS, basic life support; and CPR, cardiopulmonary resuscitation.

Circulation. 2020;142(suppl 2):S366–S468. DOI: 10.1161/CIR.0000000000000916 October 20, 2020 S373

 Panchal et al Adult Basic and Advanced Life Support: 2020 AHA Guidelines for CPR and ECC
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Figure 3. Adult Cardiac Arrest Algorithm.

CPR indicates cardiopulmonary resuscitation; ET, endotracheal; IO, intraosseous; IV, intravenous; PEA, pulseless electrical activity; pVT, pulseless ventricular tachycar-
dia; and VF, ventricular fibrillation.

S374 October 20, 2020 Circulation. 2020;142(suppl 2):S366–S468. DOI: 10.1161/CIR.0000000000000916