What is the immediate treatment for cardiac arrest?

Immediate Treatment for Cardiac Arrest

The immediate treatment for cardiac arrest is high-quality cardiopulmonary resuscitation (CPR) with chest compressions at a rate of 100-120 compressions per minute, a depth of at least 2 inches (5 cm) in adults, and minimal interruptions, followed by rapid defibrillation if a shockable rhythm is present. 1

Initial Recognition and Response

• Any unresponsive patient who is not breathing or only gasping should be treated as being in cardiac arrest 1
• Immediately activate the emergency response system while simultaneously beginning CPR 1
• Chest compressions should be the initial CPR action for all victims regardless of age 1
• For lone rescuers, the sequence is: recognition, emergency system activation, get AED/defibrillator if available, and start CPR with chest compressions 1

High-Quality CPR Components

• Provide chest compressions at a rate of 100-120 compressions per minute 1
• Ensure adequate compression depth of at least 2 inches (5 cm) in adults 1
• Allow complete chest recoil after each compression 1
• Minimize interruptions in chest compressions (aim for chest compression fraction >60%) 1
• Avoid excessive ventilation 1
• Change compressor every 2 minutes or sooner if fatigued to maintain quality 1

Ventilation During CPR

• For CPR without an advanced airway: use a 30:2 compression-to-ventilation ratio 1
• Once an advanced airway is placed, provide 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions 1, 2
• For patients on mechanical ventilation who develop cardiac arrest, disconnect from the ventilator and use manual ventilation devices 2

Defibrillation

• Apply an AED or manual defibrillator as soon as available 1
• For witnessed arrest with shockable rhythm (VF/pVT), immediate defibrillation should be performed 1
• For unwitnessed arrest, perform 2 minutes of CPR before the first rhythm analysis and potential shock 1
• Resume chest compressions immediately after shock delivery 1

Medication Administration

• Establish intravenous (IV) or intraosseous (IO) access without interrupting chest compressions 1
• For persistent VF/pVT after initial shock:
  • Administer epinephrine 1 mg IV/IO every 3-5 minutes 1, 3
  • Consider antiarrhythmic medications after failed defibrillation attempts:
    • Amiodarone: First dose 300 mg IV/IO bolus, second dose 150 mg 1, 3
    • OR Lidocaine: First dose 1-1.5 mg/kg IV/IO, second dose 0.5-0.75 mg/kg 1, 3

Special Considerations

• For cardiac arrest in the prone position with advanced airway in place: CPR may be initiated in prone position if immediate supination is not feasible 1
• For cardiac arrest in the prone position without advanced airway: turn patient supine as quickly as possible to begin CPR 1
• For post-cardiac surgery patients: immediate defibrillation for VF/VT, and immediate pacing for asystole/bradycardia if pacer wires are in place 1

Monitoring During CPR

• Use quantitative waveform capnography to confirm advanced airway placement and monitor CPR quality 1
• Target ETCO2 >10 mmHg during CPR; values <10 mmHg suggest need to improve CPR quality 1
• For patients with arterial lines, target diastolic blood pressure >20 mmHg 1

Recognition of Return of Spontaneous Circulation (ROSC)

• Check for pulse and blood pressure 1
• Look for abrupt sustained increase in ETCO2 (typically >40 mmHg) 1
• Observe for spontaneous arterial pressure waves with intra-arterial monitoring 1

Common Pitfalls to Avoid

• Delaying chest compressions to check for pulse or breathing (should take <10 seconds) 1
• Mistaking agonal gasps for normal breathing 1
• Interrupting chest compressions for prolonged periods during airway management or rhythm checks 1
• Providing excessive ventilation, which can decrease venous return and cardiac output 2
• Failing to recognize and treat potentially reversible causes of cardiac arrest 1