ACLS Algorithms 2019: Adult Cardiac Arrest

Primary Survey

  1. Pulseless Electrical Activity or PEA occurs when you see a rhythm on the monitor. It would normally be associated with a pulse. However, the patient is pulseless.
  2. The said rhythm can be anything, and at any heart rate.
  3. There’s something preventing the heart from generating a pulse. (e.g. hypovolemia, pericardial tamponade)
  4. Reassess the patient frequently for the return of pulses.

ACLS Pulseless Arrest

  1. Initiate CPR as soon as you identify pulselessness. Continue CPR at a rate of one hundred to one hundred twenty per minute. This should be done throughout the resuscitation without interruptions of more than ten seconds to evaluate for pulses.
  2. Compressors should be switched every two minutes to ensure efficacy of compressions
  3. Ventilate the patient using a Bag Valve Mask (or advanced airway if already in place) at a rate of ten per minute
  4. Waveform capnography should be utilized to monitor efficacy of compressions (should generate at least 10) and the return of pulses (will cause an increase in capnography to 40)
  5. Obtain IV/IO access
  6. Administer Epinephrine 1 mg IV/IO every 3-5 minutes
  7. Find and treat underlying causes

Managing a patient in cardiac arrest with asystole algorithm follows the same track as PEA. The precedences are the same.

  1. Following the steps in the ACLS Pulseless Arrest Algorithm.
  2. Identify and correct any treatable, underlying causes for the asystole.

The Asystole algorithm assumes that scene safety has been assured, personal protective equipment is being used. And also, no signs of obvious death are present.