From the Guidelines
During a code blue for cardiac arrest, immediately start CPR with cycles of 30 compressions and 2 breaths, and use an Automated External Defibrillator (AED) as soon as it is available. This approach is based on the most recent guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, as outlined in the 2020 American Heart Association guidelines 1. The key steps to take during a code blue include:
- Starting CPR with high-quality chest compressions at a rate of 100-120 compressions per minute, allowing for complete chest recoil between compressions
- Performing cycles of 30 compressions and 2 breaths, as recommended by the guidelines 1
- Using an AED as soon as it is available to identify the cardiac rhythm and deliver a shock if necessary
- Ensuring minimal interruptions to compressions and rotating compressors every 2 minutes to prevent fatigue, as emphasized in the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 1
- Establishing IV/IO access and attaching a cardiac monitor or defibrillator as soon as possible to identify the cardiac rhythm and guide further treatment.
From the Research
Steps to Take During a Code Blue (Cardiac Arrest)
- Call for help and alert the emergency response team 2, 3, 4
- Start CPR with continuous chest compressions, if trained to do so 3
- Use an automated external defibrillator (AED) if available and the patient is in ventricular fibrillation 5
- Administer epinephrine 1 mg intravenously if the patient has a shockable rhythm and initial CPR and defibrillation are unsuccessful, or as soon as feasible for non-shockable rhythms 4
- Consider the use of other medications such as vasopressin, steroids, and antiarrhythmics, but be aware of their limited benefits and potential risks 4, 6
- Avoid routine administration of calcium and sodium bicarbonate 4
- Continue CPR until emergency medical personnel arrive or the patient shows signs of regaining consciousness
Important Considerations
- The American Heart Association's guidelines provide a reference base for all clinicians involved in emergency cardiac care 2
- High-quality evidence suggests that bystander-administered chest compression-only CPR increases survival to hospital discharge compared to conventional interrupted chest compression CPR plus rescue breathing 3
- The use of continuous chest compression CPR with asynchronous rescue breathing may not result in higher rates of survival to hospital discharge compared to interrupted chest compression plus rescue breathing when performed by emergency medical service providers 3