A cardiac arrest is the abrupt cessation of normal blood flow circulation due to the failure of the heart to contract effectively during systole.^[1]

Cardiac arrest is a life-threatening condition and must be treated as such irrespective of the underlying cause.

• Arrhythmia
• Cardiomyopathy
• Ischemic heart disease

• Hypovolemia
• Hypoxia
• Hydrogen ions (acidosis)
• Hyperkalemia or Hypokalemia
• Hypothermia
• Hypoglycemia or Hyperglycemia

• Tablets or Toxins (tricyclic antidepressants, phenothiazines, beta blockers, calcium channel blockers, cocaine, digoxin, aspirin, acetominophen)
• Cardiac Tamponade
• Tension pneumothorax
• Thrombosis (myocardial infarction)
• Trauma (hypovolemia)

High Quality CPR: Compressions: ❑ Push hard (>2 inches) & fast (>100/min) and allow complete chest recoil ❑ Minimize interruptions; rotate compressor every 2 mins ❑ If an advanced airway is not in place ventilation:compression ratio should be 30:2 Ventilation: ❑ Avoid excessive ventilation ❑ Monitor quantitative waveform capnography; If PETco2 <10mm Hg try to improve the quality of the CPR ❑ Monitor intra-arterial pressure; if diastolic pressure <20 mm Hg try to improve the quality of the CPR Drug therapy: ❑ Establish IV/IO access (do not interrupt CPR) ❑ Vasopressor: ♦ Epinephrine 1 mg IV Q3-5 min (or 2 mg via ETT) ♦ Vasopressin 40 U can replace 2nd or 3rd doses of epinephrine) ❑ Antiarrythmic: ♦ Amiodarone 300 mg IV bolus + 150 mg 3-5 min later ♦ lidocaine 1-1.5 mg/kg IV, max 3 mg/kg Advanced airway: ❑ Endotracheal intubation or supraglottic advanced airway ❑ Assess bilateral chest expansion & breath sounds ❑ Check tube placement ❑ 8-10 breaths per min with continuous compressions Reversible causes: ❑ Hypovolemia ❑ Tension Pneumothorax ❑ Hypoxia ❑ Cardiac tamponade ❑ H+ ions ❑ Toxins ❑ Hypo/Hyper K ❑ PE ❑ Hypothermia ❑ ACS Shock energy: ❑ Biphasic: 120-200 J based on manufacturers recommendation If unknown use maximum available. Subsequent shocks should be equivalent. ❑ Monophasic: 360 J Return of Spontaneous Circulation (ROSC): ❑ Recordable pulse and BP ❑ Sudden sustained increase in PETco2 > 40 mm Hg ❑ Sustained arterial pressure waves on intra-arterial monitoring

Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 8.^[2]

Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 8.^[2]

Adapted from 2010 AHA guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, part 9.^[3]

• Chronotropic drug infusions are recommended as an alternative to pacing in symptomatic and unstable bradycardia.
• Adenosine is recommended as a safe and potentially effective therapy in the initial management of stable undifferentiated regular monomorphic wide-complex tachycardia.
• If using bag and mask ventilation, use adult mask to deliver at least 600 ml of tidal volume, sufficient to produce chest rise, over at least 1 second.
• Perform a head tilt-chin lift maneuver to open the airway, and ensure there is an airtight seal when using bag mask ventilation.
• Oropharyngeal and nasopharyngeal airways may be used to assist in bag and mask ventilation in unconscious patients.
• Continuous waveform capnography is recommended to confirm the placement of endotracehal tube.
• If the cardiac rhythm changes, shift to the appropriate rhythm based strategy.
• If you are not sure of the defibrillator’s recommended energy levels, use maximum output level.

• Do not use atropine in the management of pulseless electrical activity (PEA)/asystole.
• Do not interrupt the compressions or the use of defibrillator to place an advanced airway, secure IV/IO access or deliver drugs.
• Do not hyperventilate the patient.
• Do not use femoral pulse to assess return of spontaneous circulation (ROSC). The pause in compressions should be used to assess pulse.