What are the immediate steps for cardiac arrest management according to Advanced Cardiovascular Life Support (ACLS) guidelines?

Immediate Steps for Cardiac Arrest Management According to ACLS Guidelines

The immediate steps for cardiac arrest management according to ACLS guidelines include checking for responsiveness, breathing, and pulse simultaneously (within 10 seconds), activating emergency response, starting high-quality chest compressions at 100-120/min with a depth of at least 2 inches (5 cm), and using an AED as soon as available. 1

Initial Assessment and Recognition

• Check for responsiveness by tapping the victim and shouting "Are you all right?" 2
• Look for no breathing or only gasping and check pulse simultaneously (within 10 seconds) 2
• If no pulse is definitely felt within 10 seconds, assume cardiac arrest 2, 1
• Healthcare providers often take too long to check for a pulse, leading to delays in starting compressions, which can negatively impact survival 3

Immediate Actions

• Activate emergency response system and get AED/defibrillator (or send someone to do so) 2, 1
• Begin high-quality CPR immediately with chest compressions 2
• Perform cycles of 30 compressions and 2 breaths if no advanced airway is in place 2, 1
• Use the AED as soon as it is available 2

High-Quality CPR Components

• Push hard (at least 2 inches/5 cm) and fast (100-120/min) 2
• Allow complete chest recoil after each compression 2
• Minimize interruptions in chest compressions 2
• Avoid excessive ventilation 2
• Change compressor every 2 minutes, or sooner if fatigued 2

Rhythm Assessment and Defibrillation

• Check rhythm after 2 minutes of CPR 2
• For shockable rhythms (VF/pVT):
  • Deliver one shock immediately (biphasic: 120-200J; monophasic: 360J) 2
  • Resume CPR immediately for 2 minutes without checking pulse 2
• For non-shockable rhythms (PEA/asystole):
  • Continue CPR without defibrillation 2
  • Reassess rhythm every 2 minutes 2

Medication Administration

• Establish IV/IO access while CPR is ongoing 2
• Administer epinephrine 1 mg IV/IO every 3-5 minutes for all rhythms 2
• For persistent or recurrent VF/pVT after initial shock:
  • Administer amiodarone 300 mg IV/IO (first dose), 150 mg (second dose) 2
  • Or lidocaine 1-1.5 mg/kg IV/IO (first dose), 0.5-0.75 mg/kg (second dose) 2
  • Recent evidence suggests lidocaine may be associated with higher rates of ROSC, survival to discharge, and favorable neurologic outcomes compared to amiodarone for in-hospital cardiac arrest 4

Advanced Airway Management

• Consider advanced airway placement (endotracheal intubation or supraglottic airway) 2
• Confirm placement with waveform capnography 2
• Once advanced airway is placed, provide continuous chest compressions without pauses for ventilation 2
• Give 1 breath every 6 seconds (10 breaths/min) asynchronously with compressions 2

Identifying and Treating Reversible Causes (H's and T's)

• Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalemia, Hypothermia 2
• Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary), Thrombosis (coronary) 2

Special Considerations

• For suspected opioid overdose, administer naloxone if available 2, 3
• For hypothermic cardiac arrest, ACLS protocols including defibrillation can still be effective, though modifications may be needed 5
• Continue resuscitation efforts until advanced life support providers take over or the victim starts to move 2

Common Pitfalls to Avoid

• Delaying chest compressions while checking for pulse (limit to 10 seconds) 2, 3
• Interrupting chest compressions unnecessarily 2
• Inadequate compression depth or rate 2
• Not allowing complete chest recoil between compressions 2
• Excessive ventilation 2
• Delayed defibrillation when AED/defibrillator is available 2