Cardiac Arrest Management

Foundation of Cardiac Arrest Care

High-quality CPR with minimal interruptions and early defibrillation are crucial for improving survival, and should be prioritized over medication administration, according to the American Heart Association 1, 2
Immediate recognition and response to cardiac arrest involves checking responsiveness, breathing, and pulse simultaneously within 10 seconds, and starting CPR immediately if no pulse is found 3
Activation of emergency response and attachment of monitor/defibrillator pads should be done as soon as available to identify rhythm 3

Compression technique should involve pushing hard (at least 2 inches/5 cm depth) and fast (100-120 compressions/minute) with complete chest recoil between compressions, as recommended by the American Heart Association 2, 3
Minimizing interruptions to CPR is crucial, with all pauses kept under 10 seconds, including during rhythm checks and defibrillation, according to the American Heart Association 2, 3
Rotating compressors every 2 minutes can help prevent fatigue and maintain quality, as suggested by the American Heart Association 2

Before advanced airway placement, a ventilation strategy of 30 compressions to 2 ventilations should be used, as recommended by the American Heart Association 3
After advanced airway placement, continuous compressions with 1 breath every 6 seconds (10 breaths/minute) should be used, avoiding excessive ventilation, according to the American Heart Association 2, 3
Waveform capnography can be used to confirm airway placement and monitor CPR quality, with a target PETCO₂ >10 mmHg, as recommended by the American Heart Association 2, 3

For shockable rhythms (VF/pVT), one shock should be delivered immediately when a defibrillator is available, without delay for medications, according to the American Heart Association 2, 3
Biphasic 120-200J (manufacturer recommendation) or monophasic 360J can be used for defibrillation, as recommended by the American Heart Association 2, 3
CPR should be resumed immediately after shock for 2 minutes before rhythm reassessment, according to the American Heart Association 3
Epinephrine 1 mg IV/IO can be administered every 3-5 minutes, as recommended by the American Heart Association 2, 3

Epinephrine 1 mg IV/IO can be given every 3-5 minutes throughout the arrest, as recommended by the American Heart Association 2, 3
Amiodarone 300 mg IV/IO can be used as a first-line antiarrhythmic for shock-refractory VF/pVT, with a second dose of 150 mg, according to the American Heart Association 2
Lidocaine 1-1.5 mg/kg IV/IO can be used as an alternative first-line antiarrhythmic for shock-refractory VF/pVT, with a second dose of 0.5-0.75 mg/kg, as recommended by the American Heart Association 2

Quantitative waveform capnography can be used to confirm advanced airway placement and monitor CPR quality, with a target PETCO₂ >10 mmHg, as recommended by the American Heart Association 2, 3
Intra-arterial pressure (if available) can be used to target relaxation phase (diastolic) pressure >20 mmHg for adequate coronary perfusion, according to the American Heart Association 2
Lateral uterine displacement can be performed to relieve aortocaval compression in pregnant patients, as recommended by the American Heart Association 2, 3
Resuscitation should be continued until a hypothermic patient is rewarmed, according to the American Heart Association 3

Immediate priorities after return of spontaneous circulation (ROSC) include maintaining oxygenation, avoiding both hypoxia and hyperoxia, and maintaining hemodynamic stability, as recommended by the American Heart Association 3
Emergent coronary angiography can be considered for ST-elevation or ongoing ischemia, according to the American Heart Association 3