The Adult Cardiac Arrest Circular Algorithm illustrates how the process of CPR is CONTINUOUS, and should only be interrupted for brief rhythm checks lasting 5-10 seconds.
The GOALS of this continual process is:
- Early identification of cardiac arrest
- Quality CPR (PUSH HARD AND FAST) without interruptions.
- Early defibrillation
CPR should:
- Administer 100-120 compressions / minute
- Allow complete chest recoil
- Not be interrupted
- Avoid excessive ventilations
- Include 30:2 compression / ventilation ratio
- Include waveform capnography to assess effectiveness of CPR
In terms of defibrillation:
- Administer early
- If biphasic, administer 120 – 200 Joules.
- If monophasic, administer 360 Joules.
In terms of medication:
- Epinephrine every 3-5 minutes
- Amiodarone or lidocaine for refractory V fib or pulseless V tac
In terms of advanced airway:
- Endotracheal tube or supraglottic airway (LMA)
- Waveform capnography to monitor endotracheal tube placement
- One advanced airway in place, give 1 breath every 6 seconds with continuous compressions
In terms of ROSC:
- Check pulse and blood pressure
- End tidal CO2 will increase (>40 mm Hg)
- Intra-arterial monitoring will show pressure wave
In terms of Reversible causes of cardiac arrest:
- Consider 5 H’s and 5 T’s and treat to prevent patient from reentering cardiac arrest