Why Do You Need the Adult Cardiac Arrest Algorithm?
The ACLS cardiac arrest algorithm removes guesswork during stressful cardiac emergencies. Without this structured approach, critical interventions like proper chest compressions, timely defibrillation, and medication administration can be delayed or performed incorrectly.
The cardiac arrest algorithm makes emergency response consistent across different healthcare settings. This algorithm also reduces human error during risky situations while improving patient survival rates.
What Should You Do Before Using the ACLS Cardiac Arrest Algorithm?
Proper preparation before using the adult cardiac arrest algorithm can improve patient survival outcomes. These important steps create the foundation for effective resuscitation efforts.
- 1. Ensure Scene Safety and Recognize Cardiac Arrest: Always check for hazards, such as electrical wires, fire, or unstable surfaces, before approaching the patient. Also, confirm cardiac arrest by checking for unresponsiveness and abnormal breathing patterns.
- 2. Activate Emergency Response and Initiate High-Quality BLS: Call for help and activate your emergency response system right away. You should also start chest compressions at 100-120 per minute, pushing hard and fast with complete chest recoil.
- 3. Retrieve and Apply Defibrillator/AED: Retrieve the AED or defibrillator while CPR continues uninterrupted. You should also place the AED pads correctly on the patient’s bare chest for optimal shock delivery.
- 4. Attach the Monitor and Assess Initial Rhythm: Connect the cardiac monitor to determine the patient’s initial rhythm. This helps you decide whether defibrillation is needed or if CPR and medication should continue.
Steps for Cardiac Arrest Algorithm
The adult cardiac arrest algorithm follows a systematic approach based on whether the patient has a shockable or non-shockable rhythm. Remember that quality ACLS depends on quality BLS, so high-quality chest compressions are the foundation throughout the entire process.
1. Start with a High-Quality CPR and Rhythm Assessment
You should begin chest compressions immediately at a rate of 100-120 compressions per minute, with proper depth and complete recoil. Attach the defibrillator as quickly as possible and assess the initial rhythm. The main thing here is to minimize interruptions in chest compressions while knowing if the rhythm is shockable.
2. Identify Shockable vs Non-Shockable Rhythms
Identifying the rhythm is the most important step in this algorithm. Shockable rhythms include ventricular fibrillation and pulseless ventricular tachycardia. Non-shockable rhythms are asystole and pulseless electrical activity (PEA). PEA was also previously called electromechanical dissociation and cannot include VF, VT, or asystole patterns.
For Shockable Rhythms (VF/PVT):
1. Deliver Shock and Resume CPR
Provide shocks to the patient immediately, then resume chest compressions for 2 minutes. During these 2 minutes, the goal is to establish vascular access through IV or IO lines. Also, don’t delay compressions to start IVs.
2. Reassess Rhythm and Provide Epinephrine
After 2 minutes, recheck the rhythm. If the patient is still in VF or VT, provide another shock and resume compressions. During the next 2-minute cycle, give epinephrine 1 mg IV/IO and consider advanced airway placement. Epinephrine can be repeated every 3-5 minutes.
3. Third Shock and Amiodarone
If the patient remains in a shockable rhythm after the third shock, provide amiodarone 300 mg IV/IO bolus. This antiarrhythmic drug helps convert persistent VF/VT rhythms. Continue the cycle of CPR, rhythm checks, and shocks as needed. Finally, if the patient shows signs of return of spontaneous circulation, then proceed with the post-cardiac arrest algorithm.
For Non-Shockable Rhythms (Asystole/PEA):
1. Continue CPR and Provide Epinephrine
Do not give a shock in these rhythms. Continue providing high-quality chest compressions and give epinephrine 1 mg IV/IO immediately. You should also repeat epinephrine every 3-5 minutes throughout the resuscitation.
2. Focus on Reversible Causes
PEA and asystole can lead to poor outcomes, so identifying reversible causes becomes crucial. The leading causes of PEA are also hypoxia and hypovolemia. You should treat any identified reversible causes while maintaining continuous CPR.
3. Reassess Every 2 Minutes
Continue CPR cycles for 2 minutes, then recheck the rhythm. If the rhythm changes to VF or VT, immediately move to the shockable algorithm. If the patient develops signs of return of spontaneous circulation (ROSC), you should begin post-cardiac arrest care.
AHA ACLS Certification and Recertification
- Compliant with AHA Guidelines
- Available anytime, anywhere
- Nationally accepeted course
- Instant Certification Provided
ACLS Resource Link
ACLS Algorithm
ACLS Algorithm
Medications in the Cardiac Arrest Algorithm
The adult cardiac arrest algorithm follows a systematic approach based on whether the patient has a shockable or non-shockable rhythm. Remember that quality ACLS depends on quality BLS, so high-quality chest compressions are the foundation throughout the entire process.
Below are the medications used during cardiac arrest as outlined in the ACLS algorithm of cardiac arrest:
- Epinephrine IV/IO: During cardiac arrest, the vasopressor epinephrine is provided at a dose of 1 mg every 3-5 minutes to improve blood flow to the heart and brain. Proper administration of epinephrine increases the chances of successful defibrillation and achieving ROSC.
- Amiodarone IV/IO: Amiodarone is an antiarrhythmic used for persistent ventricular fibrillation or pulseless ventricular tachycardia after initial shocks and epinephrine. The initial dose of amiodarone is a 300 mg bolus, followed by a second dose of 150 mg if needed.
- Lidocaine IV/IO: Lidocaine, another antiarrhythmic, works as an alternative to amiodarone for refractory ventricular fibrillation or pulseless ventricular tachycardia by reducing cardiac excitability. Lidocaine is administered with an initial dose of 1-1.5 mg/kg, followed by a second dose of 0.5-0.75 mg/kg.
Assessment of ROSC in ACLS
Return of spontaneous circulation (ROSC) means that after a cardiac arrest, the heart starts beating effectively enough on its own to produce a detectable pulse and blood pressure.
Here are some signs of the return of spontaneous circulation:
- Pulse & Blood Pressure: A detectable pulse and measurable blood pressure are the signs of the proper heart’s pumping.
- Increased PetCO2 (≥40 mm Hg): A sudden rise in end-tidal carbon dioxide indicates improved lung blood flow and circulation.
- Spontaneous Arterial Waves: For monitored patients, normal pulse waves on an intra-arterial line confirm continuous blood pressure.
- Consciousness/Movement: The patient may show signs of awareness, like purposeful movement or eye-opening.
- Improved Skin Color: A shift from pale/bluish to a natural tone signals better oxygenation and perfusion.
Reversible Causes in the ACLS Cardiac Arrest Algorithm
Identifying and addressing the reversible causes is the most crucial step in any ACLS algorithm. In the context of cardiac arrest, these treatable conditions are often categorized as “H’s and T’s.”
So, here are the reversible causes in the ACLS cardiac arrest algorithm:
The H’s Include:
- Hypoxia: The condition of low level of oxygen in your blood tissues.
- Hypovolemia: The condition where your body doesn’t have a proper level of blood due to injury or illness.
- Hydrogen ion excess (acidosis): The state where your body has an excessive amount of hydrogen ions. Acidosis also indicates that your body is too acidic.
- Hyper-/hypokalemia: This condition indicates that your body has an abnormal level of potassium in your blood.
- Hypothermia: Hypothermia is a condition in which your body’s core temperature drops below 35 degrees Celsius.
Secondary Assessment:
- Tension pneumothorax: The condition where air enters the space between your lungs and chest wall (the pleural cavity).
- Toxins: Overdose or poisoning in the body due to chemicals or drugs, either intentionally or unintentionally.
- Tamponade (cardiac): The condition where fluid accumulates in the pericardial sac and prevents proper blood flow.
- Thrombosis (pulmonary): The state where blood clots, usually from somewhere else in your body, travel to your lungs and then block blood flow.
- Thrombosis (coronary): The state where a blood clot forms in one of the coronary arteries and blocks blood flow.
Our Courses
Frequently Asked Questions
How Often Should Epinephrine Be Administered During Cardiac Arrest?
During cardiac arrest, epinephrine should be administered every 3 to 5 minutes. Current ACLS guidelines recommend this dosing interval to help improve blood flow to the heart and brain during resuscitation efforts.
When Should Defibrillation Be Performed in Cardiac Arrest?
Defibrillation should be performed as quickly as possible, normally within the first few minutes of cardiac arrest. Early defibrillation improves the chances of restoring a normal heart rhythm and survival.
What Are the Four Rhythms of ACLS?
The four rhythms of ACLS are ventricular fibrillation (VF), pulseless ventricular tachycardia (pVT), pulseless electrical activity (PEA), and asystole. Identifying these rhythms is also one of the most important steps of the cardiac arrest algorithm.
What Is the CPR Ratio in ACLS?
According to the ACLS guidelines, the CPR ratio in adults is 30:2 without an advanced airway in place. This means that you need to perform 30 chest compressions and then two rescue breaths and continue this cycle.