Advanced Cardiac Life Support (ACLS): Adult Cardiac Arrest

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ACLS: Adult Arrest

1. The initial evaluation is as follows^�:

2. The initial intervention is as follows:

3. Check rhythm, as follows:

Shockable rhythm = Ventricular fibrillation or pulseless ventricular tachycardia (VF/VT)
Nonshockable rhythm = Asystole/pulseless electrical activity (PEA)

1. Initial treatment of VT/VF is as follows:

2. Administer vasopressor (epinephrine q3-5min)

3. Check pulse and rhythm every 2 minutes, as follows:

If nonshockable, see Nonshockable Rhythm (below).
If shockable, see Shockable Rhythm (above) and administer amiodarone after second defibrillation attempt.
Rotate chest compressors.
Identify and treat reversible causes.

4. If return of spontaneous circulation (ROSC),see ACLS: Post-Cardiac Arrest Care.

1. Initial treatment of asystole/PEA is as follows:

2. Administer vasopressor (epinephrine q3-5min).

3. Check pulse and rhythm every 2 minutes, as follows:

4. If return of spontaneous circulation (ROSC), see ACLS: Post-Cardiac Arrest Care

CPR should proceed as follows^�:

Push hard and fast, at least 2 inches (5 cm) and 100-120 compressions per minute.
Allow complete chest recoil.
Minimize interruptions in compressions.
Avoid excessive ventilation.
Rotate compressor every 2 minutes or if fatigued.
Compression-to-ventilation ratio is 30:2.
Continuous compressions if advanced airway present
If PETCO ₂ is low or decreasing, attempt to improve CPR quality

Shock energy should be as follows:

Biphasic: Manufacturer recommendation (eg, 120-200 J initial); if unknown, use maximum available.
Monophasic: 360 J

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Drug therapy consists of the following:

Epinephrine 1 mg IV/IO q3-5min
Amiodarone 300 mg IV/IO initial bolus dose, amiodarone 150 mg IV/IO second dose OR
Lidocaine 1st dose 1-1.5mgkg, 2nd dose 0.5-0.75mg/kg
Flush medications with 20 mL fluid after and elevate extremity for 10-20 seconds.
Combining medications is not recommended and may cause harm.
Routine use of sodium bicarbonate is not recommended and may cause harm (eg, if inadequate ventilation)
Routine use of magnesium for VF/VT is not recommended in adult patients.

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Advanced airway should be established as follows:

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Signs of ROSC include the following:

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Reversible causes include the following:

H’s: hypovolemia, hypoxia, H+ (acidosis), hypokalemia, hyperkalemia, hypothermia
T’s: toxins, tamponade (cardiac), tension pneumothorax, thrombosis (pulmonary, coronary)

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The following are updates from the 2015 guidelines:

Continuous measurement of arterial blood pressure and end-tidal carbon dioxide (ETCO2) can improve CPR quality during ALS resuscitation.
Routine use of double sequential defibrillation is not recommended.
Intravenous (IV) access is now the preferred route of administration during ACLS resuscitation. Intraosseous (IO)access is acceptable in the case that IV is not possible.
Care after ROSC including consideration of percutaneous coronary intervention, temperature control and multimodal neuroprognostication.
Emphasis on post cardiac arrest care including detailed assessment of physical, cognitive, and psychosocial needs.
Importance of debriefing individuals involved in the cardiac arrest team.