Adult Cardiac Arrest Management Algorithm

CPR Quality

• Push hard (2-2.4″ (5-6 cm)) and fast (100-120 bpm) and allow chest recoil
• Minimize interruptions
• Do not over ventilate
• If no advanced airway, 30:2 compression to ventilation ratio
• Quantitative waveform capnography
  • If ETCO₂ <10 mmHg, attempt to improve CPR quality

Shock Energy

• Biphasic: Biphasic delivery of energy during defibrillation has been shown to be more effective than older monophasic waveforms. Follow manufacturer recommendation (e.g., initial dose of 120 to 200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent and higher doses should be considered.
• Monophasic: 360 J

Return of Spontaneous Circulation

• Return of pulse and blood pressure
• Sudden sustained increase in PETCO₂ (typically ≥ 40 mmHg)
• Spontaneous arterial pressure waves with intra-arterial monitoring

Advanced Airway

• Supraglottic advanced airway or ET intubation
• Absolute placement confirmation:

1. Negative Epigastric Auscultation
2. Positive Bilateral Chest Auscultation
3. Vocal Cord Visualization
4. Quantitative ETCO2

• 10 breaths per minute with continuous chest compressions

Drug Therapy

• Epinephrine IV/IO Dose: 1 mg, administer as soon as possible then every 3 to 5 minutes after
• Amiodarone IV/IO Dose: first dose is 300 mg bolus, second dose is 150 mg
• Lidocaine: 1st dose: 1-1.5 mg/kg, second dose: 0.5-0.75 mg/kg

Reversible Causes

• Hypovolemia
• Hypoxia
• H+(acidosis)
• Hypothermia
• Hypo-/hyperkalemia
• Hypoglycemia
• Tamponade, cardiac
• Toxins
• Tension pneumothorax
• Thrombosis, pulmonary or coronary
• Trauma