Cardiac Arrest Management

Immediate Response and Recognition

The American Heart Association recommends assuming cardiac arrest in any collapsed and unresponsive individual 2
Seizure-like activity and abnormal breathing or gasping must be considered as signs of cardiac arrest until proven otherwise, as stated by the British Journal of Sports Medicine 2
The British Journal of Sports Medicine suggests immediately activating the emergency medical response system and calling for additional assistance 2

The American Heart Association recommends beginning hands-only (compression-only) CPR immediately if the patient is unresponsive and not breathing normally 2
Push hard (at least 5 cm/2 inches deep) and fast (100-120 compressions/minute), allowing complete chest recoil, as recommended by the American Heart Association 3
The American Heart Association suggests minimizing interruptions in chest compressions to maintain perfusion 3
Switch compressors every 2 minutes or sooner if fatigued to maintain effective compressions, as recommended by the American Heart Association 3
For patients without advanced airway, use a 30:2 compression-to-ventilation ratio, as suggested by the American Heart Association 3
Avoid excessive ventilation as it can impede venous return and decrease cardiac output, according to the American Heart Association 4

Apply an automated external defibrillator (AED) or manual defibrillator as soon as possible while CPR continues, as recommended by the British Journal of Sports Medicine 2
Stop CPR only for rhythm analysis and shock delivery if indicated, according to the British Journal of Sports Medicine 2
Resume CPR immediately after shock delivery for 2 minutes before reassessing rhythm, as suggested by the British Journal of Sports Medicine 2

Establish an advanced airway (endotracheal intubation or supraglottic airway device), as recommended by the American Heart Association 3
Confirm correct placement using waveform capnography, according to the American Heart Association 3
After advanced airway placement, provide 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions, as suggested by the American Heart Association 3
Monitor PETCO2 (typically 35-40 mm Hg) to assess CPR quality and detect return of spontaneous circulation, according to the American Heart Association 3

For shock-refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT), consider either amiodarone or lidocaine, as recommended by the American Heart Association 3
Amiodarone IV/IO dose: First dose 300 mg bolus, second dose 150 mg, according to the American Heart Association 3
Lidocaine IV/IO dose: First dose 1-1.5 mg/kg, second dose 0.5-0.75 mg/kg, as suggested by the American Heart Association 3
Consider vasopressors according to standard ACLS protocols, as recommended by the American Heart Association 3

Search for and treat the "H's and T's" of cardiac arrest, including hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade (cardiac), toxins, and thrombosis (coronary or pulmonary), as recommended by the American Heart Association 4

Presence of pulse and blood pressure, according to the American Heart Association 3
Abrupt sustained increase in PETCO2 (typically >40 mm Hg), as suggested by the American Heart Association 3
Spontaneous arterial pressure waves with intra-arterial monitoring, according to the American Heart Association 3

Optimize cardiopulmonary function and vital organ perfusion, as recommended by the American Heart Association 5
Transport to an appropriate hospital with comprehensive post-cardiac arrest care capabilities, according to the American Heart Association 5
Control body temperature to optimize survival and neurological recovery, as suggested by the American Heart Association 5
Consider therapeutic hypothermia (32-34°C) for comatose survivors, according to the American Heart Association 4
Identify and treat acute coronary syndromes, as recommended by the American Heart Association 5
Optimize mechanical ventilation to minimize lung injury, according to the American Heart Association 5
Elevate head of bed 30° if tolerated to reduce cerebral edema, aspiration, and ventilator-associated pneumonia, as suggested by the American Heart Association 4
Titrate inspired oxygen to achieve arterial oxygen saturation of 94% to avoid potential oxygen toxicity, according to the American Heart Association 4
Target ventilation to achieve PETCO2 of 35-40 mm Hg or PaCO2 of 40-45 mm Hg, as recommended by the American Heart Association 4

Implement performance-focused debriefing for resuscitation team members after in-hospital cardiac arrest, as recommended by the American Heart Association 6
Develop system-wide plans for proactive treatment of cardiac arrest patients, according to the American Heart Association 5
Consider transport to specialized centers with higher cardiac arrest case volumes for improved outcomes, as suggested by the American Heart Association 5

For cardiac arrest on a sports field, perform initial CPR and defibrillation at the location of collapse, as recommended by the British Journal of Sports Medicine 2
Only transfer the patient after careful consideration, as external chest compression during transit may be less effective, according to the British Journal of Sports Medicine 2
For hypothermic patients, continue CPR until rewarming is achieved, as suggested by the American Heart Association 1