Cardiac Arrest (ALS)

Algorithm

1. Confirm cardiac arrest (unresponsive, not breathing normally) → call help / arrest team; start high-quality CPR immediately (rate 100–120/min, depth 5–6 cm, full recoil, minimize interruptions).
2. Attach defibrillator/AED early; continue CPR while pads applied. Prefer antero-lateral pads; place lateral pad in mid-axillary line below the armpit (ERC 2025).
3. Shockable rhythm (VF/pVT): defibrillate ASAP (≥150 J biphasic first shock or manufacturer dose); resume CPR immediately for 2 min; minimize peri-shock pause (<5 s).
4. Adrenaline 1 mg IV: as soon as possible for non-shockable rhythms; AFTER the 3rd shock for shockable rhythms; then every 3–5 min while ALS continues (ERC 2025).
5. Amiodarone 300 mg IV after a total of 3 shocks for VF/pVT; further 150 mg after a total of 5 shocks. Lidocaine 100 mg (+50 mg after 5 shocks) if amiodarone unavailable.
6. Airway: stepwise to effective ventilation; highest feasible FiO₂ during CPR; tracheal intubation only by skilled operators with waveform capnography; ventilate ~10/min once advanced airway in place without interrupting compressions.
7. Vascular access: attempt IV first (≤2 attempts); then IO if needed. Treat reversible causes (4H/4T) without delay. Do not routinely give calcium, bicarbonate, or steroids.
8. After ROSC: ABC, SpO₂ 94–98% (avoid hyperoxia), 12-lead ECG, treat cause (ACS pathway), targeted temperature / neuroprognostication per local post-resuscitation protocol; consider ECPR in selected refractory arrests where available.