Adult pulseless arrest

End

Defibrillation (200 J)^b

Shockable: VF/pulseless VT

Nonshockable: Asystole/PEA

Epinephrine (1 mg q3-5 min)

CPR 2 min (5 cycles)

^aWhen rhythm is unclear and could be VF, treat as shockable rhythm.

^bBiphasic. One cycle of CPR should follow any successful defibrillation.

^cAmiodarone bolus should be administered in 20 to 30 mL saline or D5W. This is followed by an infusion of 1 mg/min for 6 hours and then 0.5 mg/min thereafter. An additional dose of 150 mg IV can be readministered for recurrence of VF or VT.

^dLidocaine can be bolused again at a dose of 0.5 to 0.75 mg/kg.

^eMagnesium sulfate 1 to 2 g can be considered for torsades (long-QT-associated polymorphic VT) but trials have not demonstrated an advantage. Vasopressin is no longer used in the ACLS protocol as its use had no added benefit relative to or in combination with epinephrine.

Start CPR

Assess rhythm^a

Identify and treat reversible causes:

Epinephrine (1 mg q3-5 min)

Assess rhythm^a

CPR 2 min (5 cycles)

Shock-refractory VF/pVT

Consider Magnesium^e

Amiodarone^c (300 mg)

Lidocaine^d (1-1.5 mg/kg)

Suspected torsades