Advanced Cardiac Life Support Pulseless Arrest Algorithm
Advanced Cardiac Life Support Pulseless Arrest Algorithm - Flowchart Advanced Cardiac Life Support Pulseless Arrest Algorithm Advanced Cardiac Life Support Pulseless Arrest Algorithm
«Flowchart»

1

PULSELESS ARREST


BLS algorithm: Call for help, give CPR
Give oxygen when available
Attach monitor/defibrillator when available

1

PULSELESS ARREST


BLS algorithm: Call for help, give CPR
Give oxygen when available
Attach monitor/defibrillator when available

1

1

PULSELESS ARREST

PULSELESS ARREST


BLS algorithm: Call for help, give CPR
Give oxygen when available
Attach monitor/defibrillator when available


BLS algorithm: Call for help, give CPR
Give oxygen when available oxygen
Attach monitor/defibrillator when available

9

Asystole/PEA

9

Asystole/PEA

9

9

Asystole/PEA

Asystole/PEA

3

VF/VT

3

VF/VT

3

3

VF/VT

VF/VT

2

Check rhythm
Shockable rhythm?

2

Check rhythm
Shockable rhythm?

2

2

Check rhythm
Shockable rhythm?


Shockable rhythm?

Shockable

Shockable

Shockable Shockable

Not shockable

Not shockable

Not shockable Not shockable

Continue CPR while charging device

Continue CPR while charging device

Continue CPR while charging device

Continue CPR while charging device

4

Give one shock


Manual biphasic: device specific (typically 120 to 200 J)
Note: If unknown, use 200 J
AED: device specific
Monophasic: 360 J

Resume CPR immediately
Consider advanced airway and capnography
Obtain IV/IO access

4

Give one shock


Manual biphasic: device specific (typically 120 to 200 J)
Note: If unknown, use 200 J
AED: device specific
Monophasic: 360 J

Resume CPR immediately
Consider advanced airway and capnography
Obtain IV/IO access

4

4

Give one shock

Give one shock


Manual biphasic: device specific (typically 120 to 200 J)
Note: If unknown, use 200 J
AED: device specific
Monophasic: 360 J


Manual biphasic: device specific (typically 120 to 200 J)
Note: If unknown, use 200 J

AED: device specific
Monophasic: 360 J

Resume CPR immediately
Consider advanced airway and capnography
Obtain IV/IO access

Resume CPR immediately

6

Continue CPR while defibrillator is charging
Give one shock


Manual biphasic: device specific
(same as first shock or higher dose)
Note: if unknown, use 200 J
AED: device specific
Monophasic: 360 J

Resume CPR immediately after the shock
When IV/IO available, give CPR
(before or after the shock)


Epinephrine 1 mg IV/IO
Repeat every 3 to 5 min

6

Continue CPR while defibrillator is charging
Give one shock


Manual biphasic: device specific
(same as first shock or higher dose)
Note: if unknown, use 200 J
AED: device specific
Monophasic: 360 J

Resume CPR immediately after the shock
When IV/IO available, give CPR
(before or after the shock)


Epinephrine 1 mg IV/IO
Repeat every 3 to 5 min

6

6

Continue CPR while defibrillator is charging
Give one shock


Give one shock


Manual biphasic: device specific
(same as first shock or higher dose)
Note: if unknown, use 200 J
AED: device specific
Monophasic: 360 J


Manual biphasic: device specific
(same as first shock or higher dose)
Note: if unknown, use 200 J


AED: device specific
Monophasic: 360 J

Resume CPR immediately after the shock
When IV/IO available, give CPR
(before or after the shock)

Resume CPR immediately after the shock


Epinephrine 1 mg IV/IO
Repeat every 3 to 5 min


Epinephrine 1 mg IV/IO Epinephrine
Repeat every 3 to 5 min Repeat every 3 to 5 min

Give five cycles of CPR*

Give five cycles of CPR*

Give five cycles of CPR*

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)
Note: if unknown, use 200 J
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) or
lidocaine (1 to 1.5 mg/kg first dose, then 0.5 to 0.75 mg/kg IV/IO, maximum 3 doses or 3 mg/kg)

Consider magnesium, loading dose 1 to 2 g IV/IO for torsades de pointes
After five cycles of CPR,* go to Box 5 above

8

Continue CPR while defibrillator is charging
Give one shock


Manual biphasic: device specific
(same as first shock or higher dose)
Note: if unknown, use 200 J
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) or
lidocaine (1 to 1.5 mg/kg first dose, then 0.5 to 0.75 mg/kg IV/IO, maximum 3 doses or 3 mg/kg)

Consider magnesium, loading dose 1 to 2 g IV/IO for torsades de pointes
After five cycles of CPR,* go to Box 5 above

8

8

Continue CPR while defibrillator is charging
Give one shock


Give one shock


Manual biphasic: device specific
(same as first shock or higher dose)
Note: if unknown, use 200 J
AED: device specific
Monophasic: 360 J


Manual biphasic: device specific
(same as first shock or higher dose)
Note: if unknown, use 200 J


AED: device specific
Monophasic: 360 J

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

Resume CPR immediately after the shock
antiarrhythmics


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


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

Consider magnesium, loading dose 1 to 2 g IV/IO for torsades de pointes
After five cycles of CPR,* go to Box 5 above

magnesium
After five cycles of CPR,* go to Box 5 above * *

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

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

12

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


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

7

Check rhythm
Shockable rhythm?

7

Check rhythm
Shockable rhythm?

7

7

Check rhythm
Shockable rhythm?


Shockable rhythm?

Shockable

Shockable

Shockable Shockable

No

No

No No

End

End

End

5

Check rhythm
Shockable rhythm?

5

Check rhythm
Shockable rhythm?

5

5

Check rhythm
Shockable rhythm?


Shockable rhythm?

Shockable

Shockable

Shockable Shockable

No

No

No No

10

Resume CPR immediately: five cycles or 2 minutes
When IV/IO available, give vasopressor


Epinephrine 1 mg IV/IO
Repeat every 3 to 5 min

Consider advanced airway and capnography

10

Resume CPR immediately: five cycles or 2 minutes
When IV/IO available, give vasopressor


Epinephrine 1 mg IV/IO
Repeat every 3 to 5 min

Consider advanced airway and capnography

10

10

Resume CPR immediately: five cycles or 2 minutes
When IV/IO available, give vasopressor

Resume CPR immediately: five cycles or 2 minutes


Epinephrine 1 mg IV/IO
Repeat every 3 to 5 min


Epinephrine 1 mg IV/IO Epinephrine
Repeat every 3 to 5 min Repeat every 3 to 5 min

Give five cycles of CPR*

Give five cycles of CPR*

Give five cycles of CPR*

Give five cycles of CPR* * *

13

Go to Box 4

13

Go to Box 4

13

13

Go to Box 4

Go to Box 4

11

Check rhythm
Shockable rhythm?

11

Check rhythm
Shockable rhythm?

11

11

Check rhythm
Shockable rhythm?


Shockable rhythm?

Shockable

Shockable

Shockable Shockable

Not shockable

Not shockable

Not shockable Not shockable

During CPR


Push hard (5 cm) and fast (100/min)
Ensure full chest recoil
Minimize interruptions in chest compressions
One cycle of CPR; 30 compressions then two breaths; five cycles = 2 min
Avoid hyperventilation
Secure airway and use waveform capnography to confirm and monitor
Rotate compressions every 2 min with rhythm checks or sooner if fatigued
Search for and treat possible contributing factors:


Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo-/hyperkalemia
Hypoglycemia
Hypothermia
Toxins
Tamponade, cardiac
Tension pneumothorax
Thrombosis (coronary or pulmonary)
Trauma

During CPR


Push hard (5 cm) and fast (100/min)
Ensure full chest recoil
Minimize interruptions in chest compressions
One cycle of CPR; 30 compressions then two breaths; five cycles = 2 min
Avoid hyperventilation
Secure airway and use waveform capnography to confirm and monitor
Rotate compressions every 2 min with rhythm checks or sooner if fatigued
Search for and treat possible contributing factors:


Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo-/hyperkalemia
Hypoglycemia
Hypothermia
Toxins
Tamponade, cardiac
Tension pneumothorax
Thrombosis (coronary or pulmonary)
Trauma

During CPR

During CPR During CPR


Push hard (5 cm) and fast (100/min)
Ensure full chest recoil
Minimize interruptions in chest compressions
One cycle of CPR; 30 compressions then two breaths; five cycles = 2 min
Avoid hyperventilation
Secure airway and use waveform capnography to confirm and monitor
Rotate compressions every 2 min with rhythm checks or sooner if fatigued
Search for and treat possible contributing factors:


Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo-/hyperkalemia
Hypoglycemia
Hypothermia
Toxins
Tamponade, cardiac
Tension pneumothorax
Thrombosis (coronary or pulmonary)
Trauma


Push hard (5 cm) and fast (100/min) Push hard (5 cm) and fast (100/min)
Ensure full chest recoil Ensure full chest recoil
Minimize interruptions in chest compressions Minimize interruptions in chest compressions
One cycle of CPR; 30 compressions then two breaths; five cycles = 2 min
Avoid hyperventilation
Secure airway and use waveform capnography to confirm and monitor
Rotate compressions every 2 min with rhythm checks or sooner if fatigued
Search for and treat possible contributing factors:


Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypo-/hyperkalemia
Hypoglycemia
Hypothermia
Toxins
Tamponade, cardiac
Tension pneumothorax
Thrombosis (coronary or pulmonary)
Trauma


Hypovolemia H
Hypoxia H
Hydrogen ion (acidosis) H
Hypo-/hyperkalemia H
Hypoglycemia H
Hypothermia H
Toxins T
Tamponade, cardiac T
Tension pneumothorax T
Thrombosis (coronary or pulmonary) T
Trauma T

* After an advanced airway is placed, rescuers no longer deliver “cycles” of CPR. Give continous chest compressions without pauses for breaths. Give 8 to 10 breaths/min. Check rhythm every 2 min.

* After an advanced airway is placed, rescuers no longer deliver “cycles” of CPR. Give continous chest compressions without pauses for breaths. Give 8 to 10 breaths/min. Check rhythm every 2 min.

* After an advanced airway is placed, rescuers no longer deliver “cycles” of CPR. Give continous chest compressions without pauses for breaths. Give 8 to 10 breaths/min. Check rhythm every 2 min.

*

AED, automated external defibrillator; BLS, basic life support; CPR, cardiopulmonary resuscitation; IO, intraosseous; PEA, pulseless electrical activity; U, unit; VF, ventricular fibrillation; VT, ventricular tachycardia.

AED, automated external defibrillator; BLS, basic life support; CPR, cardiopulmonary resuscitation; IO, intraosseous; PEA, pulseless electrical activity; U, unit; VF, ventricular fibrillation; VT, ventricular tachycardia.

AED, automated external defibrillator; BLS, basic life support; CPR, cardiopulmonary resuscitation; IO, intraosseous; PEA, pulseless electrical activity; U, unit; VF, ventricular fibrillation; VT, ventricular tachycardia.