Cardiac Arrest Management

Resuscitation Techniques

The American Heart Association recommends high-quality CPR with minimal interruptions, early defibrillation for shockable rhythms, administration of epinephrine every 3-5 minutes, and addressing potentially reversible causes as the cornerstone of effective resuscitation 1, 2
For shockable rhythms, the American Heart Association recommends delivering a shock immediately, resuming CPR immediately for 2 minutes after the shock, and reassessing the rhythm after 2 minutes 1
For non-shockable rhythms, the American Heart Association recommends continuing CPR and reassessing the rhythm every 2 minutes 1
CPR should be performed by pushing hard (at least 2 inches/5 cm) and fast (100-120/min), allowing complete chest recoil between compressions, and minimizing interruptions in chest compressions 2
The American Heart Association suggests rotating the compressor every 2 minutes to prevent fatigue and using a 30:2 compression-ventilation ratio if no advanced airway is present 2

The American Heart Association recommends options for advanced airway management, including endotracheal intubation and supraglottic airway device 3
After advanced airway placement, the American Heart Association recommends delivering continuous chest compressions without pauses for ventilation and providing 8-10 breaths per minute (one breath every 6-8 seconds) 2, 1, 3

The American Heart Association recommends administering epinephrine 1 mg IV/IO every 3-5 minutes for shockable rhythms, and as soon as possible, then every 3-5 minutes for non-shockable rhythms 1, 2

Hypovolemia should be treated with IV/IO crystalloid administration, hypoxia with adequate oxygenation and ventilation, and hydrogen ion (acidosis) with sodium bicarbonate for severe acidosis (pH < 7.1) 2
Hypo/hyperkalemia should be treated with appropriate electrolyte therapy, hypothermia with active rewarming, tension pneumothorax with needle decompression, and tamponade with pericardiocentesis 2
Toxins should be treated with specific antidotes if applicable, thrombosis (pulmonary) with empirical fibrinolytic therapy, and thrombosis (coronary) with reperfusion strategies 2

For patients with ROSC after cardiac arrest, post-cardiac arrest care should be initiated immediately, including treatment of hypoxemia and hypotension, and consideration of therapeutic hypothermia for comatose patients 2

The prognosis for asystole is generally poor compared to other cardiac arrest rhythms, with survival rates approximately 10-15% of those with VF/VT rhythms 4
The American Heart Association suggests considering termination of efforts after 20-30 minutes if all reversible causes have been addressed, high-quality CPR has been maintained, no signs of ROSC have been observed, and no change in rhythm has occurred 4