Adult Cardiac Arrest Circular Algorithm
CPR Quality
• Push hard (at least 2 inches [5 cm]) and fast (100-120/min)
and allow complete chest recoil.
• Minimize interruptions in compressions.
• Avoid excessive ventilation.
• Change compressor every 2 minutes, or sooner if fatigued.
Start CPR • If no advanced airway, 30:2 compression-ventilation ratio.
• Give oxygen • Quantitative waveform capnography
• Attach – If PETCO2 is low or decreasing, reassess CPR quality.
monitor/defibrillator
Return of Spontaneous Shock Energy for Defibrillation
2 minutes Circulation (ROSC)
• Biphasic: Manufacturer recommendation (eg, initial dose of
Check Post–Cardiac 120-200 J); if unknown, use maximum available. Second and
Rhythm Arrest Care subsequent doses should be equivalent, and higher doses may
If VF/pVT be considered.
Shock
• Monophasic: 360 J
Drug Therapy Drug Therapy
R IV/IO access C
P Epinephrine every 3-5 minutes o
C Amiodarone or lidocaine n • Epinephrine IV/IO dose: 1 mg every 3-5 minutes
s for refractory VF/pVT ti • Amiodarone IV/IO dose: First dose: 300 mg bolus. Second
u n dose: 150 mg.
o u or
u Consider Advanced Airway o
n u • Lidocaine IV/IO dose: First dose: 1-1.5 mg/kg. Second dose:
it Quantitative waveform capnography s 0.5-0.75 mg/kg.
no C
C Treat Reversible Causes RP Advanced Airway
• Endotracheal intubation or supraglottic advanced airway
• Waveform capnography or capnometry to confirm and
Mo y
nitor CPR Qualit monitor ET tube placement
• Once advanced airway in place, give 1 breath every 6 seconds
(10 breaths/min) with continuous chest compressions
Return of Spontaneous Circulation (ROSC)
• Pulse and blood pressure
• Abrupt sustained increase in PETCO2 (typically ≥40 mm Hg)
• Spontaneous arterial pressure waves with intra-arterial
monitoring
Reversible Causes
• Hypovolemia • Tension pneumothorax
• Hypoxia • Tamponade, cardiac
• Hydrogen ion (acidosis) • Toxins
• Hypo-/hyperkalemia • Thrombosis, pulmonary
• Hypothermia • Thrombosis, coronary
© 2020 American Heart Association
