Adult Cardiac Arrest Algorithm

1
CPR Quality
• Push hard (at least 2 inches
[5 cm]) and fast (100-120/min)
and allow complete chest recoil.
• Minimize interruptions in
compressions.
• Avoid excessive ventilation.
Yes N • Change compressor every
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 P etco 2 is low or
3 decreasing, reassess CPR
Sho quality.
Epinephri
ne 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 use maximum available.
• IV/IO access • Epinephrine every 3-5 min Second and subsequent doses
• Consider advanced airway, should be equivalent, and
capnography higher doses maybe
considered.
N • Monophasic: 360 J
Drug Therapy
Y
Y • Epinephrine IV/IO dose:
5 1 mg every 3-5 minutes
Sho • AmiodaroneIV/IO dose:
First dose: 300 mg bolus.
6 Second dose: 150 mg.
N
or
Lidocaine IV/IO dose:
First dose: 1-1.5 mg/kg.
Second dose: 0.5-0.75 mg/kg.

Advanced Airway

• Endotracheal intubation or
su- praglottic advanced
airway
N • Waveform capnography or cap-
nometry to confirm and
monitor ET tube placement
• Once advanced airway in
Y place, give 1 breathevery 6
7 seconds (10 breaths/min)
Sho with continu- ous chest
compressions
8 11 Return of
Spontaneous
CPR 2 min Circulation (ROSC)
• Amiodarone or lidocaine • Pulse and blood pressure
• Treat reversible causes • Abrupt sustained increase in
Petco2 (typically ≥40 mm Hg)
• Spontaneous arterial
pressure waves with intra-
No arterial
monitoring
Reversible Causes
12
Goto 5 or 7 • Hypovolemia
• Hypoxia
• Hydrogen ion (acidosis)
• Hypo-/hyperkalemia
• Hypothermia
• Tension pneumothorax
• Tamponade, cardiac
• Toxins
• Thrombosis, pulmonary
• Thrombosis, coronary

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