What should I do if a patient goes into cardiac arrest?

Management of Cardiac Arrest

If a patient goes into cardiac arrest, immediately begin high-quality CPR with chest compressions at a rate of 100-120 per minute and a depth of at least 2 inches (5 cm), while activating the emergency response system and obtaining an AED. 1

Initial Assessment and Actions

• Check for responsiveness by tapping the patient and shouting "Are you all right?" 1
• If unresponsive, look for no breathing or only gasping while simultaneously checking for a pulse (take no more than 10 seconds to determine if pulse is present) 1
• If no pulse is detected within 10 seconds, assume cardiac arrest 1
• Activate the emergency response system immediately 1
• Get an AED/defibrillator or send another rescuer to do this 1
• Begin high-quality CPR immediately 1

High-Quality CPR Technique

• Push hard: Compress chest at least 2 inches (5 cm) 1
• Push fast: Maintain a rate of 100-120 compressions per minute 1
• Allow complete chest recoil after each compression 1
• Minimize interruptions in chest compressions 1
• Avoid excessive ventilation 1
• Perform cycles of 30 compressions to 2 breaths until an advanced airway is placed 1
• Change compressor every 2 minutes or sooner if fatigued to maintain quality 1

When AED/Defibrillator Arrives

• Turn the AED on 1
• Follow the AED prompts 1
• If a shockable rhythm is detected, deliver one shock 1
• Resume CPR immediately after the shock for 2 minutes 1
• Minimize interruptions in chest compressions when checking rhythm 1

Advanced Interventions (for Healthcare Providers)

• Establish IV/IO access for medication administration 1
• Administer epinephrine 1 mg IV/IO every 3-5 minutes 1
• For refractory VF/pVT, consider amiodarone (first dose: 300 mg bolus, second dose: 150 mg) or lidocaine (first dose: 1-1.5 mg/kg, second dose: 0.5-0.75 mg/kg) 1
• Place an advanced airway (endotracheal tube or supraglottic airway) 1
• After advanced airway placement, provide continuous chest compressions with asynchronous ventilations (1 breath every 6 seconds, or 10 breaths per minute) 1
• Use waveform capnography to confirm and monitor endotracheal tube placement 1

Consider Reversible Causes

• Hypovolemia 1
• Hypoxia 1
• Hydrogen ion (acidosis) 1
• Hypo-/hyperkalemia 1
• Hypothermia 1
• Tension pneumothorax 1
• Tamponade, cardiac 1
• Toxins 1
• Thrombosis, pulmonary 1
• Thrombosis, coronary 1

Special Considerations

• For lone rescuers, activate emergency response system first, then begin CPR 1
• When two or more rescuers are present, one should begin chest compressions while the second activates the emergency response system and gets the AED 1
• Continue CPR until advanced life support providers take over or the patient shows signs of life 1
• For healthcare providers, check pulse for no more than 10 seconds to avoid unnecessary delays in starting CPR 1

Common Pitfalls to Avoid

• Taking too long to check for a pulse, which delays CPR initiation 1
• Interrupting chest compressions for prolonged periods, which decreases perfusion 1
• Providing inadequate compression depth, which reduces blood flow 1
• Failing to allow complete chest recoil, which impairs cardiac filling 1
• Excessive ventilation, which increases intrathoracic pressure and decreases venous return 1
• Delaying defibrillation when an AED is available 1

Following these evidence-based guidelines will maximize the chance of survival with good neurological outcomes for patients experiencing cardiac arrest.