Cardiac Arrest (Adult)
 
Cardiac Arrest
Immediately commence CPR at 30:2
If suspected severe hypothermia (i.e. cold water emersion)
               
Unconscious / Pulseless VF / VT   Pulseless Electrical Activity (PEA)   Asystole
Defibrillate Single shock
  200J Biphasic
    (360J Monophasic)		   Identify and Mx causes   Confirm rhythm on 3 leads and with printed ECG strip.

Repeat Single shock
2 minutely if VF/VT persists
(not if T=<30c)

• Hypoxia
• Anaphylaxis
• Asthma
• Exsanguination
• Upper airway obstruction
• Tension pneumothorax		    
               
VF/VT persists   PEA persists   Asystole persists
IV access / Normal Saline TKVO   IV access / Normal Saline TKVO   IV access / Normal Saline TKVO
Adrenaline 1mg IV
- Repeat 3 minutely if no output
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C)		   Adrenaline 1mg IV
- Repeat 3 minutely if no output
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C) 		  Adrenaline 1mg IV
- Repeat 3 minutely if no output
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C)
OR Consider I/O if delay in IV
- Adrenaline 1mg I/O
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C) 		  OR Consider I/O if delay in IV
- Adrenaline 1mg I/O
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C) 		  OR Consider I/O if delay in IV
- Adrenaline 1mg I/O
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C)
               
VF/VT persists   PEA persists   Asystole persists
Insert LMA   Insert LMA   Insert LMA
Change CPR ratio to 15:1   Change CPR ratio to 15:1   Change CPR ratio to 15:1
Intubate   Intubate   Intubate
Change CPR ratio to 15:1   Change CPR ratio to 15:1   Change CPR ratio to 15:1
If unable to obtain IV or I/O
- Adrenaline 2mg via ETT
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C) 		  If unable to obtain IV or I/O
- Adrenaline 2mg via ETT
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C) 		  If unable to obtain IV or I/O
- Adrenaline 2mg via ETT
  (6 minutely if T=30-32˚C)
  (no repeats if T <30˚C)
               
VF/VT persists   PEA persists      
Amiodarone 300mg IV   Normal Saline 20ml/kg IV      
Stop   OR Normal Saline 20ml/kg IO      
Amiodarone is contraindicated in confirmed or suspected Tricyclic antidepressant medication OD            
               
VF/VT persists            
Repeat Amiodarone 150mg IV (max. combined dose 450mg)
(not if T=<30˚C)		            
               
VF/VT persists   PEA persists   Asystole persists
After 15min Paramedic CPR   After 15min Paramedic CPR   After 15min Paramedic CPR
Sodium Bicarbonate 8.4% 50ml IV (unless T=<30˚C)   Sodium Bicarbonate 8.4% 50ml IV (unless T=<30˚C)   Sodium Bicarbonate 8.4% 50ml IV (unless T=<30˚C)
               
ROSC   ROSC   ROSC
Treat as per ROSC Mx   Treat as per ROSC Mx   Treat as per ROSC Mx
 
Sodium Bicarbonate may be administered earlier in the algorithm if hyperkalaemia suspected or in cardiac arrest secondary to TCA overdose