Which statement about cardiopulmonary resuscitation (CPR) is correct?

E) In ventricular fibrillation, the first action is defibrillation

Statement E is correct: In ventricular fibrillation (VF), the first action is immediate defibrillation. This is the cornerstone of VF management and is consistently emphasized across all major resuscitation guidelines 1, 2.

Analysis of Each Statement

Statement E (CORRECT): VF requires immediate defibrillation

• The 2020 AHA Guidelines explicitly state that when VF/pulseless VT is identified, "the first defibrillating shock must be given without any delay" 1
• Early defibrillation is the single most important intervention for VF, as survival decreases with every minute of delay 2
• The algorithm is clear: Check rhythm → If VF/pVT → Deliver shock immediately → Then resume CPR for 2 minutes 1
• Shock energy recommendations: Biphasic 120-200 Joules initially (or manufacturer recommendation); Monophasic 360 Joules 1

Statement A (INCORRECT): Sodium bicarbonate is NOT always administered

• Sodium bicarbonate has no routine role in cardiac arrest 3
• It should only be used in specific circumstances: severe acidosis (pH <7.1, base excess <-10), hyperkalemia, or tricyclic antidepressant overdose 3
• The evidence against routine bicarbonate use is strong, as it can worsen intracellular acidosis and has not improved outcomes in trials 3

Statement B (INCORRECT): Compression rate is 100-120/min, NOT 60-70/min

• The correct chest compression rate is 100-120 compressions per minute 1, 2, 4
• A rate of 60-70/min is dangerously inadequate and would not generate sufficient cardiac output
• High-quality CPR requires: adequate rate (100-120/min), adequate depth (at least 2 inches/5 cm in adults), complete chest recoil, and minimal interruptions 1, 2

Statement C (INCORRECT): Asystole does NOT require defibrillation

• Asystole is a non-shockable rhythm 1, 3
• The first action for asystole is immediate CPR, not defibrillation 1, 3
• Management includes: high-quality CPR, epinephrine every 3-5 minutes, atropine 3 mg once, and searching for reversible causes 3
• Attempting to defibrillate asystole is futile and delays effective CPR

Statement D (INCORRECT): Calcium gluconate is NOT for hypokalemia

• This statement has the indication backwards
• Calcium is administered for hyperkalemia (high potassium), not hypokalemia (low potassium)
• Calcium helps stabilize the cardiac membrane in hyperkalemia-induced cardiac arrest
• Hypokalemia would be treated with potassium replacement, not calcium

Key Clinical Pearls

For VF/pulseless VT management:

• Time is myocardium: Every minute of delay in defibrillation decreases survival by 7-10%
• The sequence is: CPR → Rhythm check → Shock (if VF/pVT) → Immediate CPR for 2 minutes → Repeat 1
• Do not check pulse immediately after shock; resume CPR immediately 4
• Epinephrine 1 mg IV/IO every 3-5 minutes during CPR 1
• Consider amiodarone 300 mg or lidocaine 1-1.5 mg/kg for refractory VF/pVT after multiple shocks 1, 5

Common pitfall: Delaying defibrillation to establish IV access or administer medications. The shock comes first for VF—nothing else has been proven to improve survival like early defibrillation 2.