Ventricular Fibrillation or Pulseless Ventricular Tachycardia

If return of circulation fails

Continue chest compressions, intubate, IV access

FAIL

Epinephrine, 1 mg IV -or- Vasopressin, 40 units IV; follow with repeat defibrillation at maximum energy within 30-60 s as required; repeat epinephrine

If return of circulation fails

If return of circulation fails

Amiodarone: 150 mg over 10 min, 1 mg/min
Lidocaine: 1.5 mg/kg; repeat in 3–5 min
Magnesium sulfate: 1–2 gm IV (polymorphic VT)
Procainamide: 30 mg/min, to 17 mg/kg [monomorphic VT]

Defibrillate, CPR: Drug-Shock-Drug-Shock

Antiarrhythmics

End

Immediate defibrillation within 5 min of onset; 60-90 seconds of CPR before defibrillation for delay ≥5 min

2 min of chest compressions at >100/min followed by repeat shock; repeat sequence twice if needed

If return of circulation fails

If return of circulation fails

If return of circulation fails

Epinephrine, ↑ dose

Antiarrhythmics

NaHCO₃, 1 meq/kg (↑ K⁺ ) (no longer for routine use; may be used for persistent acidosis-see text)