Adult Cardiac Arrest Management Algorithm

CPR Quality

• Push hard enough to reach 2-2.4″ (5-6 cm) depth and fast enough for 100-120 beats per minute, allowing recoil between every press
• Limit interruptions
• Avoid over-ventilating
• If no advanced airway is available, use a 30:2 compression to ventilation ratio
• Perform quantitative waveform capnography (attempt to improve CPR quality if ETCO₂ < 10 mmHg

Shock Energy

• Biphasic: Older monophasic waveforms are not nearly as effective as the delivery of biphasic energy during defibrillation. For the right doses, stick to manufacturer recommendations; if these are not available, use the maximum setting available. The next doses must be equivalent and potentially higher.
• Monophasic: 360 J

Return of Spontaneous Circulation

• Perform ET intubation or supraglottic advanced airway
• Observe and confirm ET tube placement with waveform capnography
• With continuous chest compressions, apply 8 to 10 breaths every minute

Advanced Airway

• Supraglottic advanced airway or ET intubation
• Waveform capnography to confirm and monitor ET tube placement
• 10 breaths per minute with continuous chest compressions

Drug Therapy

• Epinephrine IV/IO Dose: 1 mg every 3 to 5 minutes
• Amiodarone IV/IO Dose: initial dose of 300 mg bolus and the second dose of 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