Cardiac Arrest Circular Algorithm

When to Use This Algorithm

Use this algorithm when an adult patient experiences cardiac arrest, indicated by unresponsiveness, absence of normal breathing, and no detectable pulse. Immediate action is crucial to improve the chances of survival.

Steps in the Algorithm

1. Start CPR
   • Begin cardiopulmonary resuscitation (CPR) immediately.
   • Provide oxygen and attach a monitor/defibrillator.
   • Ensure chest compressions are performed at a rate of 100-120 per minute with a depth of at least 2 inches, allowing full chest recoil.
2. Check Rhythm
   • Assess the patient’s cardiac rhythm to determine if it is shockable (VF/pVT).
   • Quickly assess the rhythm on the monitor, ensuring minimal interruption in chest compressions.
3. Shock if VF/pVT
   • Deliver an electric shock using a defibrillator if a shockable rhythm is present.
   • Clear the area around the patient to avoid accidental shock to rescuers.
4. Perform CPR Continuously
   • Continue CPR for 2 minutes between rhythm checks.
   • Rotate compressors every 2 minutes to prevent fatigue and maintain high-quality compressions.

Drug Therapy

• IV/IO Access
  • Gain intravenous or intraosseous access for medication administration.
  • Administer epinephrine every 3-5 minutes and consider amiodarone for refractory VF/pVT.

Consider Advanced Airway

• Advanced Airway Management
  • Consider endotracheal intubation or supraglottic advanced airway devices.
  • Use waveform capnography to confirm and monitor endotracheal tube placement.
  • Once the advanced airway is in place, give 1 breath every 6 seconds (10-12 breaths/min) with continuous chest compressions.

Treat Reversible Causes

• Identify and Treat Reversible Causes
  • Actively look for and treat reversible causes, including the H’s and T’s (Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary and coronary)).

Monitor CPR Quality

• CPR Quality Monitoring
  • Push hard (at least 2 inches) and fast (100-120/min) and allow complete chest recoil.
  • Minimize interruptions in compressions.
  • Avoid excessive ventilation.
  • Rotate compressors every 2 minutes, or sooner if fatigued.
  • If no advanced airway, use 30:2 compression-ventilation ratio.
  • If PETCO2 (capnography) is <10 mm Hg, attempt to improve CPR quality.
  • If diastolic pressure is <20 mm Hg, attempt to improve CPR quality.

Return of Spontaneous Circulation (ROSC)

• Evaluate ROSC
  • Look for signs of Return of Spontaneous Circulation (ROSC), including a pulse and blood pressure, abrupt sustained increase in PETCO2 (typically ≥40 mm Hg), and spontaneous arterial pressure waves with intra-arterial monitoring.
  • If ROSC is achieved, transition to post-cardiac arrest care, including optimizing ventilation and oxygenation, treating hypotension, and considering targeted temperature management.

Key Takeaways

Effective management of adult cardiac arrest involves immediate CPR, timely defibrillation for shockable rhythms, and continuous reassessment of the patient's condition. Administering medications like epinephrine and antiarrhythmics, along with addressing reversible causes, are crucial steps. Advanced airway management and continuous monitoring of CPR quality are essential for maximizing the chances of Return of Spontaneous Circulation (ROSC).

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