Adult Cardiac Arrest
High-performance CPR and advanced life support for adult cardiac arrest
Basic
Cardiac
Updated
1/15/2024
Approved By
Medical Director
Version
2024.1
Elapsed
00:00
Indications
- •Pulseless ventricular tachycardia (pVT)
- •Ventricular fibrillation (VF)
- •Pulseless electrical activity (PEA)
- •Asystole
Contraindications
- •Obviously dead (rigor mortis, decomposition)
- •Do Not Resuscitate (DNR) order
- •Traumatic arrest with incompatible with life injuries
Protocol Steps
Follow these steps in sequence for optimal patient care
1
Assess Responsiveness
Check consciousness and breathing
CRITICAL
≤10 seconds
Actions:
- →Tap shoulders and shout "Are you okay?"
- →Look for normal breathing (no more than 10 seconds)
- →Check carotid pulse (no more than 10 seconds)
2
Activate Emergency Response
Call for help and equipment
CRITICAL
Immediate
Actions:
- →Call 911 or activate emergency response
- →Request AED/defibrillator
- →Request additional personnel if available
3
Begin High-Quality CPR
Start compressions immediately
CRITICAL
Continuous
Actions:
- →Position hands on lower half of breastbone
- →Compress at least 2 inches (5 cm) deep
- →Allow complete chest recoil between compressions
- →Minimize interruptions (<10 seconds)
- →Compression rate 100-120/min
- →Switch compressors every 2 minutes
Success Criteria:
- Compression depth: At least 2 inches (5 cm)
- Rate: 100-120 compressions per minute
- Fraction: >80% of cycle time
4
Airway Management
Establish and maintain airway
HIGH
Actions:
- →Use bag-mask ventilation initially
- →Consider supraglottic airway if trained
- →Endotracheal intubation by qualified provider
- →Confirm placement with capnography
- →Secure airway device
Success Criteria:
- ETCO2 35-45 mmHg
- Bilateral breath sounds
- Chest rise with ventilation
Important Notes:
- • Minimize interruptions during airway placement
- • Continuous compressions during advanced airway
5
Rhythm Analysis and Defibrillation
Analyze rhythm and deliver shock if indicated
CRITICAL
<5 seconds interruption
Actions:
- →Attach monitor/defibrillator pads
- →Analyze rhythm
- →Charge defibrillator if VF/pVT
- →Clear area and deliver shock
- →Resume CPR immediately after shock
Success Criteria:
- Shockable: VF, pVT
- Non-shockable: PEA, Asystole
6
Medication Administration
Administer ACLS medications per protocol
HIGH
Actions:
- →Establish IV/IO access
- →Epinephrine 1mg IV/IO every 3-5 minutes
- →Consider antiarrhythmic for refractory VF/pVT
- →Amiodarone 300mg IV/IO (first dose)
- →Amiodarone 150mg IV/IO (second dose)
Important Notes:
- • Continue CPR during medication preparation
- • Flush medications with 20mL normal saline
7
Treat Reversible Causes (H's and T's)
Identify and treat potential causes
MEDIUM
Actions:
- →Hypovolemia: Give fluids, blood products
- →Hypoxia: Improve ventilation/oxygenation
- →Hydrogen ion (acidosis): Hyperventilation
- →Hypokalemia/Hyperkalemia: Correct electrolytes
- →Hypothermia: Rewarm gradually
- →Tension pneumothorax: Needle decompression
- →Tamponade: Pericardiocentesis
- →Toxins: Specific antidotes
- →Thrombosis: Thrombolytics, PCI
8
Post-ROSC Care
Immediate post-resuscitation care
HIGH
Actions:
- →Confirm pulse and blood pressure
- →Optimize ventilation (ETCO2 35-45 mmHg)
- →Treat hypotension (SBP >90 mmHg)
- →Consider induced hypothermia
- →Obtain 12-lead ECG
- →Prepare for transport to appropriate facility
Success Criteria:
- ROSC defined as sustained pulse >20 minutes
- Target MAP >65 mmHg
- SpO2 94-99%
Required Equipment
•AED/Manual defibrillator
•CPR feedback device
•Bag-mask ventilator
•Oxygen source
•Suction equipment
•IV/IO supplies
•Medications (epinephrine, amiodarone)
•Capnography monitor
•Blood pressure monitor
Protocol Medications
Epinephrine
IV, IO, ET (2-2.5 times IV dose)
All cardiac arrest rhythms
Adult Dose:1 mg IV/IO every 3-5 minutes
Pediatric Dose:0.01 mg/kg IV/IO every 3-5 minutes
Onset:1-3 minutes
Duration:5-10 minutes
Amiodarone
IV, IO
Refractory VF/pVT
Adult Dose:300 mg IV/IO, then 150 mg IV/IO
Pediatric Dose:5 mg/kg IV/IO, may repeat
Onset:Minutes to hours
Duration:30-45 days
Evidence Base & References
- 1.2020 American Heart Association Guidelines for CPR and ECC
- 2.Panchal AR, et al. Part 3: Adult Basic and Advanced Life Support. Circulation. 2020;142(16_suppl_2):S366-S468.
- 3.Neumar RW, et al. Part 1: Executive Summary. Circulation. 2015;132(18 Suppl 2):S315-67.