Management of Cardiac Arrest

Beginning high-quality CPR is the first management step in cardiac arrest.

Quality CPR consists of:

• A rate of 100 to 120 compressions per minute
• A compression depth of one-third the diameter of the chest (1.5 inches in infants (4 cm) and 2 inches (5 cm) in children)
• Minimize interruptions
• Never over-ventilate
• Every two minutes, rotate compressor
• 30:2 compression ventilation ratio for one provider and 15:2
  compression ventilation ratio for two providers if no advanced airway
• 10 to 15 breaths per minute for one provider or 20 to 30 breaths per
  minute for two providers with continuous chest compressions if there is advanced airway

Shock Energy

• First shock: 2 J/kg
• Second shock: 4 J/kg
• Subsequent shocks: greater than or equal to 4 J/kg
• Maximum dose of the shock: 10 J/kg or adult dose

Return of Spontaneous Circulation

• Return of pulse and blood pressure
• Spontaneous arterial pressure waves with intra-arterial monitoring

Advanced Airway

• Supraglottic advanced airway or ET intubation
• Waveform capnography to observe and confirm ET tube placement
• Give one breath every 2 to 3 seconds, or 20 to 30 breaths per minute, once advanced airway is in place

Drug Therapy

• Epinephrine IV/IO dose: 0.01 mg/kg (repeat every 3 to 5 minutes; if no IO/IV access, may give endotracheal dose of 0.1 mg/kg)
• Amiodarone IV/IO dose: 5 mg/kg bolus during cardiac arrest (repeat up to two times if necessary for refractory VF/pulseless VT)

Reversible Causes

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