1

Pulseless arrest

Basic life support algorithm; call for help and give CPR.
Give oxygen when available.
Attach monitor/defibrillator when available.

3

Ventricular fibrillation or ventricular tachycardia

9

Asystole or pulseless electrical activity (PEA)

4

Give one shock.

Manual biphasic: device-specific (typically 120 to 200 J)
Automated external defibrillator (AED): device-specific
Monophasic: 360 J

Resume CPR immediately after the shock.

Give five cycles of CPR.^*

6

Continue CPR while defibrillator is charging.

Give one shock.

Manual biphasic: device-specific (same as first shock or higher dose)
AED: device-specific
Monophasic: 360 J

When IV/IO available, give vasopressor during CPR (before or after the shock)

Epinephrine IV/IO

Repeat every 3 to 5 minutes.

or

May give 1 dose of vasopressin 40 units IV/IO to replace first or second dose of epinephrine.

Give five cycles of CPR.^*

8

Continue CPR while defibrillator is charging.

Give one shock.

Manual biphasic: device-specific (same as first shock or higher dose)
AED: device-specific
Monophasic: 360 J

Resume CPR immediately after the shock.

Consider antiarrhythmics; give during CPR (before or after the shock)

amiodarone (300 mg IV/IO once, then consider additional 150 mg IV/IO once)
lidocaine (1 to 1.5 mg/kg first dose, then 0.5 to 0.75 mg/kg IV/IO; maximum three doses or 3 mg/kg).

amiodarone (300 mg IV/IO once, then consider additional 150 mg IV/IO once)
lidocaine (1 to 1.5 mg/kg first dose, then 0.5 to 0.75 mg/kg IV/IO; maximum three doses or 3 mg/kg).

*

After an advanced airway is placed, rescuers no longer deliver "cycles" of CPR. Give continuous chest compressions without pauses for breaths. Give 8 to 10 breaths/minute. Check rhythm every 2 minutes.

7

Check rhythm.
Shockable rhythm?

Shockable

Not shockable

End

2

Check rhythm.
Shockable rhythm?

Shockable

Not shockable

10

Resume CPR immediatelly for five cycles.

When IV/IO available, give vasopressor

epinephrine 1 mg IV/IO

Repeat every 3 to 5 minutes.

or

May give 1 dose of vasopressin 40 units IV/IO to replace first or second dose of epinephrine.

Consider atropine 1 mg IV/IO for asystole of slow PEA rate; repeat every 3 to 5 minutes (up to three doses).

Give five cycles of CPR.^*

12

If asystole, go to Box 10.
If electrical activity, check pulse. If no pulse, go to Box 10.
If pulse present, begin postresuscitation care.

13

Go to Box 4.

11

Check rhythm.
Shockable rhythm?

Shockable

Not shockable

5

Check rhythm.
Shockable rhythm?

Shockable

Not shockable