From the Guidelines
The cardiac arrest algorithm should prioritize high-quality CPR, early defibrillation, and medication administration, with a focus on minimizing interruptions to chest compressions and addressing reversible causes. Here's a concise overview:
- Start immediate high-quality CPR: 30 compressions to 2 breaths, at a rate of 100-120 compressions per minute, with a depth of at least 2 inches or 5 cm for an average adult, while avoiding excessive chest compression depths greater than 2.4 inches or 6 cm 1.
- Attach defibrillator/monitor as soon as possible and analyze rhythm every 2 minutes.
- For shockable rhythms (VF/pVT):
- Deliver shock (biphasic 120-200J or monophasic 360J)
- Resume CPR immediately for 2 minutes
- Give epinephrine 1 mg IV/IO every 3-5 minutes
- Consider amiodarone 300 mg IV/IO after the third shock, followed by 150 mg if needed
- For non-shockable rhythms (asystole/PEA):
- Continue CPR
- Give epinephrine 1 mg IV/IO every 3-5 minutes
- Address reversible causes (Hs and Ts):
- Hypoxia, Hypovolemia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia
- Tension pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary/coronary)
- Consider advanced airway placement (endotracheal tube or supraglottic device)
- Continuously reassess and adjust treatment based on patient response This algorithm prioritizes maintaining blood flow to vital organs through high-quality CPR and early defibrillation for shockable rhythms, and is supported by the most recent guidelines from the American Heart Association 1. Epinephrine increases coronary perfusion pressure, while amiodarone helps stabilize cardiac electrical activity. Addressing reversible causes is crucial for successful resuscitation, and minimizing interruptions to chest compressions is key to improving outcomes.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Cardiac Arrest Management Algorithm
The algorithm for managing cardiac arrest involves several steps, including:
- Establishing the diagnosis and deciding whether to resuscitate 2
- Administering a precordial thump, noting the time and summoning aid 2
- Establishing a patent airway and performing artificial ventilation and external cardiac compression 2
- Instituting general supportive measures 2
- Diagnosing the cardiac arrhythmia responsible for the arrest 2
- Treating the arrhythmia 2
- Managing the patient after resuscitation 2
Updates to the Algorithm
Recent research has led to updates in the algorithm, including:
- Prioritizing coronary and cerebral perfusion over airway management 3
- Deemphasizing endotracheal intubation 3
- Changing the order of CPR steps from "ABC" to "CAB" to emphasize the importance of chest compressions 4
Chain of Survival
The American Heart Association (AHA) has suggested the chain of survival concept, which includes four links:
- Early access
- Cardiopulmonary resuscitation (CPR)
- Defibrillation
- Advanced care 5 This concept has withstood a decade of scrutiny, but additional research efforts are needed to support the concepts included in the chain of survival for cardiac arrest patients 5
Airway Management
Airway management is critical to successful cardiac arrest resuscitation, and recent studies have provided clarity on the timing and method of airway management during cardiac arrest 6 A stepwise approach to airway management, the utility of various airway adjuncts, and best practices for oxygenation and ventilation in the peri-arrest period are also important considerations 6