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 CPR with a rate of 100-120 compressions per minute and 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
• Simultaneously look for no breathing or only gasping and check pulse (within 10 seconds) 2, 1
• If no pulse is definitely felt within 10 seconds, assume cardiac arrest 2
• Activate emergency response system and get AED/defibrillator (or send someone to do so) 2, 1

High-Quality CPR

• Start chest compressions immediately if no pulse is detected 2, 1
• Push hard at a depth of at least 2 inches (5 cm) at a rate of 100-120 compressions per minute 2, 3
• Allow complete chest recoil after each compression 2, 3
• Minimize interruptions in chest compressions 2
• Perform cycles of 30 compressions and 2 breaths if no advanced airway is in place 2, 1
• Change compressor every 2 minutes, or sooner if fatigued 2
• Once an advanced airway is placed, provide continuous chest compressions with 1 breath every 6 seconds (10 breaths/min) 2, 1

Rhythm Assessment and Defibrillation

• Use AED/defibrillator as soon as it is available 2, 1
• Check rhythm after 2 minutes of CPR 2
• For shockable rhythms (VF/pVT):
  • Deliver one shock immediately 2
  • Resume CPR immediately for 2 minutes after shock 2
  • For biphasic defibrillators: use manufacturer recommendation (120-200 Joules) 2
  • For monophasic defibrillators: use 360 Joules 2
• For non-shockable rhythms (PEA/asystole):
  • Resume CPR immediately for 2 minutes 2
  • Recheck rhythm every 2 minutes 2

Medication Administration

• Establish IV/IO access while CPR is ongoing 2, 1
• For all rhythms: Administer epinephrine 1 mg IV/IO every 3-5 minutes 2, 1
• For refractory VF/pVT: Consider amiodarone 300 mg IV/IO (first dose) followed by 150 mg (second dose) or lidocaine 1-1.5 mg/kg IV/IO (first dose) followed by 0.5-0.75 mg/kg (second dose) 2, 4

Advanced Airway Management

• Consider advanced airway placement (endotracheal intubation or supraglottic airway) 2, 1
• Confirm placement with waveform capnography or capnometry 2, 1
• Once advanced airway is placed, provide 1 breath every 6 seconds (10 breaths/min) with continuous chest compressions 2, 1

Identifying and Treating Reversible Causes

• Consider and treat potential reversible causes (H's and T's) 2, 1:
  • Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia 2, 1
  • Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary), Thrombosis (coronary) 2, 1

Common Pitfalls and Caveats

• Healthcare providers often take too long to check for a pulse, leading to delays in starting compressions 2, 5
• Incomplete chest recoil prevents full cardiac refilling 5, 3
• Excessive ventilation can increase intrathoracic pressure and decrease venous return 2, 1
• Interruptions in chest compressions significantly decrease survival chances 2, 3
• Failure to consider and treat reversible causes can lead to unsuccessful resuscitation 2, 1