Cardiac Arrest Management Using ACLS and EKG Strips

Initial Assessment and Recognition

The American Heart Association recommends checking for responsiveness, breathing, and pulse simultaneously (within 10 seconds); if no pulse is detected, begin CPR immediately 1, 2
The American Heart Association suggests activating the emergency response system and obtaining an AED/defibrillator 2
Attach cardiac monitor/defibrillator pads as soon as available to identify the cardiac arrest rhythm, as recommended by the American Heart Association 1

The American Heart Association recommends pushing hard (at least 2 inches/5 cm) and fast (100-120 compressions/min) with complete chest recoil 1, 3
Minimize interruptions in chest compressions, keeping pauses under 10 seconds, as suggested by the American Heart Association 2, 3
For healthcare providers: perform cycles of 30 compressions to 2 ventilations until an advanced airway is placed, as recommended by the American Heart Association 2
After advanced airway placement, provide continuous compressions with 1 breath every 6-8 seconds (8-10 breaths/min), as suggested by the American Heart Association 3

For VF/pVT, deliver one shock as soon as defibrillator is available, as recommended by the American Heart Association 1
Use manufacturer-recommended energy for biphasic defibrillators (typically 120-200J) or 360J for monophasic defibrillators, as suggested by the American College of Cardiology 4
Resume CPR immediately after shock for 2 minutes before rhythm reassessment, as recommended by the American Heart Association 1, 2
Administer epinephrine 1mg IV/IO every 3-5 minutes, as suggested by the American Heart Association 1, 4
For refractory VF/pVT (after 2-3 shocks), consider antiarrhythmic drugs, such as Amiodarone or Lidocaine, as recommended by the American College of Cardiology 4

Consider advanced airway placement (endotracheal tube or supraglottic airway) without interrupting chest compressions, as suggested by the American Heart Association 3
Confirm proper placement with waveform capnography, as recommended by the American Heart Association 6, 4
After advanced airway placement, deliver 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions, as suggested by the American Heart Association 1, 3

Use quantitative waveform capnography to confirm and monitor advanced airway placement, as recommended by the American Heart Association 6, 4
Monitor CPR quality (target PETCO₂ >10 mmHg) using quantitative waveform capnography, as suggested by the American College of Cardiology 4
Note that ETCO₂ should not be used alone as a mortality predictor or to terminate resuscitation, as recommended by the American Heart Association 6

For patients with Return of Spontaneous Circulation (ROSC), maintain oxygenation and ventilation (avoid both hypoxia and hyperoxia), as suggested by the American Heart Association 6
Maintain hemodynamic stability, as recommended by the American Heart Association 6
Consider emergent coronary angiography for patients with ST-segment elevation on ECG or signs of ongoing myocardial damage, as suggested by the American College of Cardiology 8

For pregnant patients, perform lateral uterine displacement to relieve aortocaval compression, as recommended by the American College of Cardiology 4
For hypothermic patients, continue resuscitation efforts until the patient is rewarmed, as suggested by the American Heart Association 9, 7
Consider ECPR (extracorporeal CPR) for select patients when conventional CPR is failing, particularly in witnessed arrests with shockable rhythms, as recommended by the American Heart Association 8, 6