ADVANCED CARDIAC ARREST

ALGORITHM
2015
Adult and Paediatric 2015

Has pulse Has pulse but no

and breathing effective breathing
Give rescue breaths
Place in recovery
position Adult: every 6 seconds
Check for continued Child: every 5 seconds
breathing No Pulse or not sure Infant: every 4 seconds
Reassess continuously Pulse rate <60 in
children and infants Reassess continuously

Start Compressions High Quality CPR:

Compress the chest fast (almost 2 per second)
Push hard / Ensure full chest recoil /
Minimize interruptions
Compression rate 100 120 per minute
Avoid excessive ventilation;
1 breath every 6 seconds if advanced airway
Rotate compressors every 2 minutes
Consider capnography and arterial monitoring

Breaths Advanced Considerations:

If unable to Correct contributory causes
Attempt 2 breaths at 1 breath/second perform breaths, Obtain IV/IO access, take ABG/VBG
(with if available) after every 30 compressions do continuous Give high levels of Fi and consider
compressions advanced airway if required
until Continuous chest compressions
equipment after advanced airway in place
Consider Adrenaline and
arrives antiarrhythmics:
Continue until AED / Deb arrives
Adrenaline 1mg every 3 - 5 min
(0.01mg/kg in paed)
Attach AED / Deb immediately Amiodarone 300mg followed by
150mg (5mg/kg in paed)
or if not available
ANALYSE Lignocaine 1.5mg/kg initial,
RHYTHM followed by 0.5mg/kg (max 3mg/kg)

Shock Advised No Shock Advised Contributory Causes:

(VF/VT) (PEA/Asystole) Hypoxia
Hypovolaemia
Hypothermia
Give 1 Shock Hydrogen ion (Acidosis)
Hypo- / Hyperkalaemia
Monophasic 360J Hypoglycaemia
Biphasic 120-360J Tension Pneumothorax
Paediatric 4J/kg Tamponade (Cardiac)
Toxins
Immediately resume CPR Immediately resume CPR Trauma
starting with compressions. starting with compressions. Thrombosis (Coronary)
Continue for 2 minutes Thrombosis (Pulmonary)
Continue for 2 minutes
Additional considerations:
1) VA ECMO might be considered in appropriate centres when available;
2) Ultrasound can be considered as a diagnostic and procedural tool where training and resources exist.

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