Cardiopulmonary Resuscitation (CPR) Guidelines

Initial Assessment and Resuscitation

The American Heart Association recommends immediately beginning high-quality chest compressions at a depth of at least 2 inches (5 cm) and rate of 100-120 per minute with minimal interruptions, using a 30:2 compression-to-ventilation ratio for single rescuers, and defibrillate shockable rhythms as soon as possible while administering epinephrine 1 mg IV/IO every 3-5 minutes for all cardiac arrest rhythms 1, 2
Verify scene safety and check for responsiveness by shouting and tapping the patient, and simultaneously assess for normal breathing and check for a pulse within 10 seconds 4
Immediately activate the emergency response system and retrieve an automated external defibrillator (AED) if the patient has no pulse or no normal breathing 4

The American Heart Association recommends pushing hard with a depth of at least 2 inches (5 cm) in adults, or at least one-third of the anteroposterior diameter in children, and maintaining a rate of 100-120 compressions per minute 5, 1, 2
Allow complete chest recoil between each compression without leaning on the chest, and minimize interruptions in compressions to less than 10 seconds 1, 2
Change the compressor every 2 minutes or sooner if fatigued to maintain quality 5, 1, 2

Deliver each rescue breath over 1 second with sufficient volume to achieve visible chest rise, and avoid excessive ventilation which increases intrathoracic pressure and decreases cardiac output 6, 1, 2
Administer supplemental oxygen as soon as available 5, 1, 2

Use the AED or manual defibrillator as soon as it becomes available, and check the cardiac rhythm after 2 minutes of CPR 4, 5
For shockable rhythms, deliver one shock immediately and resume CPR for 2 minutes before rechecking rhythm 4, 5, 3
Do not delay defibrillation to establish IV access or administer medications in shockable rhythms 1, 2

Establish intravenous (IV) or intraosseous (IO) access for medication delivery, and administer 1 mg IV/IO of epinephrine every 3-5 minutes throughout the resuscitation 5, 1, 2, 3
Consider amiodarone or lidocaine for shock-refractory VF/pulseless VT, with dosages of 300 mg IV/IO bolus for amiodarone and 1-1.5 mg/kg IV/IO for lidocaine 1, 2

Place an endotracheal tube or supraglottic airway device when trained personnel are available, and confirm tube placement immediately using waveform capnography or capnometry 5, 1, 2, 3, 7
Once advanced airway is secured, provide 1 breath every 6 seconds (10 breaths/minute) with continuous chest compressions 1, 2, 7

Maintain mean arterial pressure ≥65 mmHg using vasopressors as needed, and target oxygen saturation of 92-98% to avoid both hypoxemia and hyperoxemia 3, 7
Obtain 12-lead ECG immediately to identify ST-elevation myocardial infarction, and consider urgent coronary angiography for suspected cardiac etiology 7
Initiate targeted temperature management for patients who do not follow commands after ROSC 7

Systematically evaluate and treat reversible causes throughout resuscitation, including hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade (cardiac), toxins, thrombosis (pulmonary), and thrombosis (coronary) 7