Chest compressions at 100-120/min
Immediate defibrillation (150-200 J biphasic)

2 min of chest compressions/ventilation then repeat shock

End

CPR, cardiopulmonary resuscitation; PCI, percutaneous coronary intervention; ROSC, return of spontaneous circulation; VF, ventricular fibrillation; VT, ventricular tachycardia.

No ROSC

No ROSC

Continue chest compressions
IV or intraosseous access
Advanced airway
Epinephrine 1 mg every 3-5 min
Repeat shock

No ROSC

IV amiodarone 300 mg (may repeat 150 mg)
Continue CPR
Repeat shock

Specific therapies

Polymorphic VT/VF

ACS: Lidocaine, PCI
Long QT: Magnesium, transvenous pacing, isoproterenol

Monomorphic VT

Consider lidocaine or procainamide

Sinusoidal VT

Hyperkalemia: Calcium, NaHCO₃