Adult Cardiac Arrest Algorithm

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Adult Cardiac Arrest Algorithm

ACLS Cardiac Arrest Algorithm

Figure 29

CPR Quality

  • Push hard (≥ 2 inches) and fast (≥ 100 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 mm Hg, attempt to improve CPR quality
  • Intra-arterial pressure
    • If diastolic pressure < 20 mm Hg, 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 mm Hg)
  • Spontaneous arterial pressure waves with intra-arterial monitoring

Advanced Airway

  • Supraglottic advanced airway or ET intubation
  • Waveform capnography to confirm and monitor ET tube placement
  • 8 to 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: first dose is 300 mg bolus, second dose is 150 mg

Reversible Causes

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