Cardiac Arrest Cardiac Arrest Cardiac Arrest AlgorithmAlgorithmAlgorithm

Cardiac Arrest Algorithm(Adult or Pediatric)

- Confi rm unresponsiveness and call for assistance- Confi rm cardiac arrest and begin CPR (C-A-B)

- Attach cardiac monitor/defi brillator

V-Fib or Pulseless V-Tach

Shock 1

CPR 2 minutes• IVorIOaccess

Shock 1

CPR 2 minutes• Epinephrineevery3-5min.• Consideradvancedairway

• Waveformcapnography

1

2

3

4

Shock 1

5

6

7

CPR 2 minutes• Amiodarone• Treatreversiblecauses

8

Shockable rhythm ?

YES

Shockable rhythm ?

YES

Asystole or PEA9

CPR 2 minutes• IVorIOaccess• Epinephrineevery3-5min.• Consideradvancedairway

• Waveformcapnography

10

Shockable rhythm ?

NO

CPR 2 minutes• Treatreversiblecauses

11

Shockable rhythm ?

NO YES

YES

• IfnosignsofROSC,gotobox10or11• IfROSC,gotopost-cardiacarrestcare

12

NO

NO

Go to box 5 or 7

CPR 2010Matrix 2

CPR Quality Pushhard(atleast2inchesintheadult—at

leastonethirdoftheanterior–posteriordiam-eterofthechestininfants[about1½inches]andchildren[about2inches])—andfast(atleast100/min).Allowfullchestrecoilinbetweencompressions.

Switchcompressorevery2minutes.Avoidexcessiveventilation.MinimizeCPRinterruptions.

Compression-to-ventilationratio: Alladultandsingle-rescuerCPR:30:2 Two-rescuerinfantandchildCPR:15:2

BeginasynchronousCPRaftertheadvancedairwayhasbeeninserted.Useacompressionrateofatleast100/minandventilationsat8to10breaths/min(onebreathevery6to8seconds).

Waveformcapnography IfETCO

210mmHg,attempttoimprove

CPRquality

Drug Doses and Intervals

Epinephrine: Adult:1mgIV/IOevery3–5minutes Pediatric:

IV/IOdose:0.01mg/kg(0.1mL/kgof1:10,000solution)every3to5min

ETdose(ifnoIVorIO):0.1mg/kg(0.1mL/kgof1:1,000solution)

Vasopressin: Adult:40units(IV/IO)one timetoreplace

firstorseconddoseofepinephrine Pediatric:notapplicable

Amiodarone: Adult:300mginitialdose;150mgsecond

dose Pediatric:5mg/kgIVorIO;mayrepeat

twiceatsamedose;maximumof15mg/kg

Advanced Airway Insertsupraglotticairwaydeviceor

endotrachealtube. Usequantitativewaveformcapnographyto

confirmandmonitorETtubeplacement.

BeginasynchronousCPRaftertheadvancedairwayhasbeeninserted.Useacompressionrateofatleast100/minandventilationsat8to10breaths/min(onebreathevery6to8seconds).Donothyperventilate!

Defibrillation Energy

Adult: Biphasic:Manufacturerrecommendation

(120to200J);ifunknown,usemaximumavailable.Secondandsubsequentdosesshouldbeequivalent;higherdosesmaybeconsidered.

Monophasic:360J.

Pediatric: Firstshockat2J/kg;secondshockat4J/kg;

subsequentshocksatleast4J/kg. Maximumshock:10J/kgoradultenergysetting.

Reversible Causes Hypovolemia Hypoxia Hydrogenion(acidosis) Hypoglycemia(especiallyininfantsand

children) Hypokalemia/hyperkalemia Hypothermia Tensionpneumothorax Tamponade,cardiac Toxins(drugoverdose,poisoning) Thrombosis,pulmonary Thrombosis,coronary

Return of Spontaneous Circulation (ROSC)

AbruptandsustainedincreaseinETCO2

(typically40mmHg);palpablepulse. AssessBP.Obtain12-leadECG.Maintain

SpO294%. MaintainBPwithIV/IOfluidbolusor

vasopressor. Doesthepatientfollowcommands?

NoConsiderinducedhypothermia YesSTEMIorhighsuspicionofAMI

Advancedcriticalcare;coronaryreperfusion