Adult Cardiac Arrest Management Algorithm

Initial Recognition and Response

The American Heart Association recommends immediately beginning high-quality chest compressions at a rate of 100-120/min and depth of at least 2 inches (5 cm) as soon as cardiac arrest is recognized, as this is the single most critical intervention for survival 1
Check for responsiveness while simultaneously assessing breathing and pulse, and look for absent or only gasping respirations (agonal gasps are common and should not be mistaken for normal breathing) 1, 2, 3
If pulse is not definitively palpated within 10 seconds, immediately start CPR, as pulse checks are notoriously unreliable even among trained providers 1, 2

The American Heart Association recommends a compression-to-ventilation ratio of 30:2 until an advanced airway is placed, with a compression depth of at least 2 inches (5 cm) and a compression rate of 100-120 per minute 1, 6, 7
Allow complete chest recoil between compressions and minimize interruptions, as any pause reduces perfusion pressure 6, 7
Change compressor every 2 minutes or sooner if fatigued, to maintain high-quality CPR 6, 7

For shockable rhythms (VF/pulseless VT), deliver one shock immediately, followed by resumption of CPR for 2 minutes without a pulse check 1, 6, 4
Use a biphasic defibrillator with a dose of 120-200 Joules (or manufacturer recommendation) or a monophasic defibrillator with a dose of 360 Joules 6, 4, 7

Consider endotracheal intubation or supraglottic airway once advanced providers arrive, and use waveform capnography to confirm tube placement (PETCO2 monitoring) 6, 4, 7
After advanced airway placement, deliver 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions (no pauses for ventilation) 6, 4, 7
Establish IV or IO access as soon as feasible without interrupting compressions, and administer epinephrine at a dose of 1 mg IV/IO every 3-5 minutes throughout resuscitation 6, 4, 7

Recognize ROSC by palpable pulse and measurable blood pressure, abrupt sustained increase in PETCO2 ≥40 mmHg, or spontaneous arterial pressure waves on invasive monitoring 6, 4, 7
When ROSC is achieved, immediately transition to post-cardiac arrest care 6, 4, 7

In pregnant patients, immediate defibrillation takes priority over all other interventions, including perimortem cesarean section, and perform manual left lateral uterine displacement to relieve aortocaval compression 8
Position compressions slightly higher on the sternum to account for the elevated diaphragm, and use standard ACLS defibrillation doses without modification 8