ACLS Ventricular Fibrillation Preparation

Equipment Preparation

The American Heart Association recommends ensuring defibrillator is immediately available and functional with appropriate energy settings (biphasic: manufacturer recommendation 120-200J; monophasic: 360J) 1
Prepare airway management equipment including bag-mask device with HEPA filter, especially for suspected COVID-19 patients, as recommended by the American Heart Association 3
The American Heart Association suggests preparing supraglottic airway devices or endotracheal intubation equipment, and waveform capnography for confirming and monitoring advanced airway placement 1, 2
Establish suction devices with large-bore, non-kinking suction tubing and semi-rigid pharyngeal tips, and adequate vacuum (>40 L/min airflow, >300 mmHg vacuum when clamped), as recommended by the American Heart Association 4
Prepare IV/IO access equipment for medication administration, as suggested by the American Heart Association 5

The American Heart Association recommends preparing amiodarone for refractory VF/pVT, with a first dose of 300 mg bolus IV/IO, and a second dose of 150 mg IV/IO 5
Prepare lidocaine for refractory VF/pVT, with a first dose of 1-1.5 mg/kg IV/IO, and a second dose of 0.5-0.75 mg/kg IV/IO, as suggested by the American Heart Association 5
Prepare epinephrine 1 mg IV/IO, to be administered every 3-5 minutes, as recommended by the American Heart Association 2

Assign clear roles to team members, including compressor(s) to perform high-quality chest compressions, and airway manager to secure and maintain the airway, as recommended by the American Heart Association 1
Plan for compressor rotation every 2 minutes to minimize fatigue and maintain high-quality compressions, as suggested by the American Heart Association 1, 5
Ensure all team members wear appropriate PPE, especially when aerosol-generating procedures are anticipated, as recommended by the American Heart Association 3

Set up quantitative waveform capnography to monitor CPR quality, with a target PETCO2 <10 mmHg, as recommended by the American Heart Association 1, 5
Consider intra-arterial pressure monitoring if available, with a target relaxation phase pressure <20 mmHg, as suggested by the American Heart Association 1, 5
Prepare for continuous assessment of compression rate (100-120/min), compression depth (at least 2 inches/5 cm), complete chest recoil, and minimal interruptions in compressions, as recommended by the American Heart Association 1, 5

Review VF/pVT algorithm with team, including immediate recognition of cardiac arrest, early CPR with minimal interruptions, rhythm check and defibrillation as soon as possible, and consideration of antiarrhythmic drugs after 2-3 shocks, as recommended by the American Heart Association 1, 2, 5

For pregnant patients, prepare for lateral uterine displacement to relieve aortocaval compression, as recommended by the American Heart Association 3
For suspected COVID-19 patients, ensure appropriate PPE and HEPA filters on ventilation equipment, as suggested by the American Heart Association 3
Consider ECPR (extracorporeal CPR) preparation for select patients when conventional CPR is failing, as recommended by the American Heart Association 6

Avoid excessive ventilation (maintain 8-10 breaths/minute with advanced airway), as recommended by the American Heart Association 1, 2
Minimize interruptions in chest compressions, including during advanced airway placement, as suggested by the American Heart Association 2, 7
Avoid delays in defibrillation while preparing medications, as recommended by the American Heart Association 8
Don't rely solely on ETCO2 cutoff values for prognostication or termination decisions, as suggested by the American Heart Association 6
Prevent prolonged pulse checks; if pulse is not definitely felt within 10 seconds, resume CPR, as recommended by the American Heart Association 3