Adult Cardiac Arrest Algorithm (VF/pVT/Asystole/PEA)

1
High-Quality CPR
Start CPR
• Begin bag-mask ventilation • Push hard (at least 2 inches
and give oxygen [5 cm]).
• Attach monitor/defibrillator • Push fast (100-120/min)
and allow complete chest recoil.
• Minimize interruptions in
compressions.
• Avoid excessive ventilation.
Yes Rhythm No • Change compressor every
shockable? 2 minutes, or sooner if fatigued.
• If no advanced airway, use 30:2
2 9 compression-ventilation ratio.
• If advanced airway in place, give
VF/pVT Asystole/PEA 1 breath every 6 seconds
(10 breaths/min) with continuous
chest compressions.
• Continuous waveform
3 Shock Epinephrine capnography
ASAP – If ETCO2 is low or decreasing,
reassess CPR quality.
4 10
Shock Energy for Defibrillation
CPR 2 min CPR 2 min
• IV/IO access • Biphasic: Manufacturer
• IV/IO access
• Epinephrine every 3-5 min recommendation (eg, initial
• Consider advanced airway, dose of 120-200 J); if unknown,
capnography use maximum available.
Second and subsequent doses
Rhythm No should be equivalent, and higher
shockable? doses may be considered.
• Monophasic: 360 J
Rhythm Yes
Yes Drug Therapy
shockable?
5 Shock • Epinephrine IV/IO dose:
1 mg every 3-5 minutes
No • Amiodarone IV/IO dose:
6 First dose: 300 mg bolus
CPR 2 min Second dose: 150 mg
or
• Epinephrine every 3-5 min Lidocaine IV/IO dose:
• Consider advanced airway, First dose: 1-1.5 mg/kg
capnography Second dose: 0.5-0.75 mg/kg

Advanced Airway

No • ET intubation or supraglottic
Rhythm advanced airway
shockable? • Continuous waveform
capnography or capnometry
Yes to confirm and monitor ET tube
placement
7 Shock
Reversible Causes

• Hypovolemia
8 11 • Hypoxia
CPR 2 min CPR 2 min • Hydrogen ion (acidosis)
• Amiodarone or lidocaine • Hypo-/hyperkalemia
• Treat reversible causes • Hypothermia
• Treat reversible causes
• Tension pneumothorax
• Tamponade, cardiac
• Toxins
No Yes • Thrombosis, pulmonary
Rhythm • Thrombosis, coronary
shockable?

12
• If no signs of ROSC, go Go to 5
to 10
• If ROSC, go to post–
cardiac arrest care
• Consider appropriateness
of continued resuscitation

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 Adult Post–Cardiac Arrest Care Algorithm Initial Stabilization After ROSC
Resuscitation is ongoing during the post-
ROSC obtained ROSC phase, and many of these activities
can occur concurrently.
Manage airway: Assess and consider
placement or exchange of an advanced
Manage airway airway device (usually endotracheal tube
Assess airway. or supraglottic device). Confirm correct
Place or exchange an advanced airway device, placement of an advanced airway. This
as necessary. generally includes the use of waveform
Confirm correct airway placement. capnography or capnometry.
Manage oxygenation and ventilation:
Manage oxygenation and ventilation Titrate Fio2 for Spo2 90%-98% (or Pao2
Initial Maintain 100% Fio2 until Spo2 (or Pao2) can be 60-105 mm Hg). Adjust minute ventilation
stabilization measured reliably. to target Pco2 35-45 mm Hg in the
after ROSC Spo2 target 90%-98% (Pao2 60-105 mm Hg) absence of severe acidemia.
Pco2 target 35-45 mm Hg Manage hemodynamics: Initiate
or adjust vasopressors and/or fluid
Manage hemodynamics resuscitation as necessary for goal MAP
≥65 mm Hg.
Target MAP ≥65 mm Hg
Early diagnostic testing: Obtain 12-lead
ECG to assess for ischemia or arrhythmia.
Consider CT head, chest, abdomen, and/
Early diagnostic testing or pelvis to determine cause of arrest
Obtain 12-lead ECG. or assess for injuries sustained during
Consider diagnostic imaging resuscitation. Point-of-care ultrasound
(CT and/or ultrasound). or echocardiography may be reasonable
to identify clinically significant diagnoses
requiring intervention.

Continued Management
Treat arrest etiologies and complications.
Consider emergency coronary angiography Treat arrest etiologies and
and/or mechanical circulatory support. complications.
Consider emergency cardiac
intervention:
• Persistent ST-segment elevation
Assess patient off sedation and present
neuromuscular blockade, if able. • Cardiogenic shock
• Recurrent or refractory ventricular
arrhythmias
• Severe myocardial ischemia
Follows
Temperature control: If patient is not
Continued No or commands?
Yes following commands off sedation and
management unsure
neuromuscular blockade or is unable to
assess, initiate a deliberate strategy of
Ongoing critical care Ongoing critical care temperature control with goal 32 °C-37.5 °C
as soon as possible.
Deliberate strategy for Coronary angiography Evaluate for seizure: Evaluate for clinical
temperature control when appropriate seizure and obtain EEG to evaluate
for seizure in patients not following
commands.
EEG Prognostication: Multimodal approach
with delayed impressions (≥72 hours from
ROSC or achieving normothermia).
Coronary angiography
when appropriate Ongoing critical care includes the
following:
• Target Pao2 60-105 mm Hg, Pco2 35-45
Appropriately timed, mm Hg (unless severe acidemia); avoid
multimodal prognostication hypoglycemia (glucose <70 mg/dL) and
hyperglycemia (glucose >180 mg/dL);
target MAP ≥65 mm Hg.
• Consider antibiotics.
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Adult Tachyarrhythmia With a Pulse Algorithm

Assess appropriateness of heart rate Doses/Details

for clinical condition. Heart rate typically Synchronized cardioversion:
≥150/min if tachyarrhythmia. Refer to your specific device’s recommended energy level or to
relevant 2025 Guidelines sections to maximize first shock success.
If not known, use the maximum energy setting.
Adenosine IV dose:
First dose: 6 mg rapid IV push; follow with NS flush.
Initial assessment and support Second dose: 12 mg if required.
• Maintain patent airway; assist breathing as necessary Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia
• Oxygen (if hypoxemic) Procainamide IV dose:
• Continue cardiac monitoring to identify rhythm;
20-50 mg/min until arrhythmia suppressed, hypotension ensues,
monitor blood pressure and oximetry
QRS duration increases >50%, or maximum dose 17 mg/kg given.
• IV access
Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.
• 12-lead ECG, if available
Amiodarone IV dose:
First dose: 150 mg over 10 minutes. Repeat as needed if VT recurs.
Follow by maintenance infusion of 1 mg/min for first 6 hours.

Persistent tachyarrhythmia
causing
Yes Synchronized cardioversion
• Hypotension?
• Sedate whenever feasible
• Acutely altered mental status?
• Signs of shock? • If regular narrow complex,
consider adenosine If refractory, consider
• Ischemic chest discomfort?
• Underlying cause
• Acute heart failure?
• Need to increase
energy level for next
No cardioversion
• Addition of anti-
Consider arrhythmic drug
Yes • Adenosine only if regular • Expert consultation
Wide QRS?
≥0.12 second and monomorphic
• Antiarrhythmic infusion
No • Expert consultation

• Vagal maneuvers (if regular)

• Adenosine (if regular)
• β-Blocker or calcium channel blocker
• Consider expert consultation
© 2025 American Heart Association
Electrical Cardioversion Algorithm

Tachycardia
With serious signs and symptoms
caused by the tachycardia

If ventricular rate is >150/min, prepare for

immediate cardioversion. May give brief
trial of medications based on specific
arrhythmias. Immediate cardioversion is
generally not needed if heart rate is ≤150/min.

Have available at bedside

• Oxygen saturation monitor
• Suction device
• IV line
• Intubation equipment

Sedate whenever feasible*

Synchronized cardioversion†‡
Atrial fibrillation: 200 J
Atrial flutter: 200 J
Narrow-complex tachycardia: 100 J
Monomorphic VT: 100 J
Polymorphic VT: unsynchronized, high-energy shock (defibrillation)

Notes

*Effective regimens have included a sedative (eg, diazepam) with or without

an analgesic agent (eg, fentanyl). Many experts recommend anesthesia if
service is readily available.
†Note possible need to resynchronize after each cardioversion.
‡If delays in synchronization occur and clinical condition is critical, go
immediately to unsynchronized shocks.

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Adult Bradycardia With a Pulse Algorithm

Assess appropriateness for clinical

condition. Heart rate typically
<50/min if bradyarrhythmia.

Cardiopulmonary
compromise?
• Hypotension?
• Acutely altered No
mental status?
• Signs of shock?
• Ischemic chest
discomfort?
• Acute heart
failure?

Yes

Doses/Details
Assessment and support • Identify and treat
• Maintain patent airway and provide oxygen underlying causes Atropine IV dose:
• Assist breathing with positive-pressure – Support ABCs First dose: 1 mg bolus.
ventilation as necessary – Consider oxygen Repeat every 3-5 minutes.
• Attach cardiorespiratory monitor – Obtain 12-lead ECG Maximum total dose: 3 mg.
• Monitor pulse • Observe
Dopamine IV infusion:
Usual infusion rate is
5-20 mcg/kg per minute.
Titrate to patient response;
taper slowly.
Bradycardia No
persists with Epinephrine IV infusion:
cardiopulmonary 2-10 mcg per minute infusion.
compromise? Titrate to patient response.

Possible Causes
Yes
• Myocardial ischemia/
infarction
• Drugs/toxicologic (eg,
Atropine
calcium-channel blockers,
If atropine ineffective: β-blockers, digoxin)
• Transcutaneous pacing • Hypoxia
and/or • Electrolyte abnormality
• Dopamine or (eg, hyperkalemia)
epinephrine infusion

Consider:
• Expert consultation
• Transvenous pacing

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Adult* Basic Life Support Algorithm for Health Care Professionals

Verify scene safety.

• Check for responsiveness.

• Shout for nearby help.
• Activate emergency response system.
• Send someone to get AED/defibrillator.

Normal Abnormal
• Provide breaths, 1 breath every
breathing, Look for no breathing breathing,
6 seconds or 10 breaths/min.
Monitor until pulse felt or only gasping, and check pulse felt
• Check pulse every 2 minutes;
advanced care pulse (simultaneously). if no pulse, start CPR.
arrives. Is pulse definitely felt • If suspected opioid overdose,
within 10 seconds? administer opioid antagonist
(eg, naloxone) if available.

No breathing
or only gasping,
pulse not felt

Start CPR
• Perform cycles of 30 compressions
and 2 breaths.
• Use AED/defibrillator as soon as it
is available.
• If suspected opioid overdose,
consider opioid antagonist
(eg, naloxone).

AED arrives.

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

• Give 1 shock. Resume CPR • Resume CPR immediately for 2

immediately for 2 minutes (until minutes (until prompted by AED/
prompted by AED/defibrillator to defibrillator to allow rhythm check).
allow rhythm check). • Continue until ALS professionals
• Continue until ALS professionals take over or person starts to move.
take over or person starts to move.

*If signs of puberty, treat as adult.

© 2025 American Heart Association