- Initial Actions:
- Open airway
- Give breath
- Start CPR
- 100% O2 by BVM (initially)
- Code cart
- Place cardioversion/defibrillation pads
- Establish IV/IO
- Monitors (Rhythm, Oximetry, BP)
- Secondary Actions:
- Defibrillation, unsynchronized at 2 J/kg (monophasic) or utilize AED if >1 year of age (use pediatric pads if available). Resume CPR immediately.
- 5 Cycles (or 1-2 minutes) of High Quality CPR.
- Intubated: 100 compressions/minute and 8-10 breaths/minute.
- BVM: 15 compressions then 2 breaths = 1 cycle.
- CPR to continue uninterrupted until resuscitation successful.
- Administer epinephrine as soon as IV/IO is established (repeat q3-5 minutes):
- IV/IO: 0.01 mg/kg (1:10,000 = 0.1 mL/kg)
- ETT: 0.1 mg/kg (1:1,000 = 0.1 mL/kg)
- Establish advanced airway if not already established
- After 5 cycles (1-2 minutes) of CPR, check rhythm.
6a) Shockable Rhythm (VF/VT): Defibrillation at 4 J/kg (monophasic) or utilized AED if >1 year of age (use pediatric pads if available). Resume CPR immediately.
6b) No shockable rhythm:
- Asystole: Change to Asystole protocol
- If electrical activity, check pulse; if no pulse, change to PEA protocol, if pulse present, begin postresuscitation care
- If remains in VF/VT, continue with CPR with epinephrine q3-5 minutes, rhythm check every 5 cycles (1-2 minutes) of CPR, defibrillation as indicated after every 5 cycles (1-2 minutes of CPR). Continue at higher dose (4 J/kg) for subsequent shocks.
- Administer antiarrhythmic agent (choose 1):
- Amiodarone 5 mg/kg IV/IO bolus
- Lidocaine 1 mg/kg IV bolus
- Magnesium sulfate 25-50 mg/kg IV/IO for torsades de pointes (Max 2 grams)
- Consider reversible causes
- Hypoxia
- Hypovolemia such as severe dehydration or massive hemorrhage
- Hypoglycemia (especially in newborns, infants)
- Hypothermia
- Poisoning such as beta blockers, TCA's, Digoxin
- Metabolic causes such as hyperkalemia, hypokalemia, acidosis
- Trauma such as tension pneumothorax, cardiac tamponade, aortic rupture
- Myocardial Infarction or Pulmonary Embolus
Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.