ACLS algorithm

Priority 1: CPR Follow recommendations for BLS.

Perform CPR for at least 2 minutes before the first rhythm check (see
“Priority 2”).
Do not interrupt CPR, except for rhythm and pulse checks.
Consider advanced airway device placement only if necessary and feasible
without major interruption of CPR.
See “Ensuring high-quality CPR” for details.
Priority 2: Rhythm and pulse check Pause CPR no longer than 10 seconds.
If either of the following shockable rhythms is identified, proceed first to
“Priority 3”:
 Ventricular fibrillation
 Ventricular tachycardia
If either of the following nonshockable rhythms is identified, proceed
directly to “Priority 4”:
 PEA
 Asystole
See “Rhythms in cardiac arrest” for details.
Repeat pulse and rhythm check every 2 minutes.
See “Endpoints” for reasons to stop resuscitation.
Priority 3: Defibrillation (shockable rhythms only)
Deliver shock as soon as a shockable rhythm is recognized (do not
defibrillate nonshockable rhythms).
Resume CPR immediately after shock delivery.
Continue CPR for a full 2 minutes.
Reassess rhythm and pulse (return to “Priority 2”).
If 2nd cycle of defibrillation is unsuccessful, proceed to “Priority 4.”
See “Defibrillation” for details.
Priority 4: Resuscitation medications Requires IV or IO access; place
peripheral IV/IO access and administer medications without interrupting
CPR.
Nonshockable rhythms: epinephrine 1 mg IV/IO as soon as possible; repeat
every 35 minutes as needed
Shockable rhythms
After 2nd cycle of defibrillation: epinephrine 1 mg IV/IO
After 3rd unsuccessful cycle of defibrillation
Amiodarone 300 mg IV/IO; then 150 mg IV/IO once after 35 minutes
OR lidocaine 11.5 mg/kg IV/IO once, then 0.50.75 mg/kg IV/IO once after
35 minutes
Repeat epinephrine every 35 minutes as needed
See “Resuscitation medications” for details.
Reevaluate need for repeat dosing or further medication at next pulse and
rhythm check (return to “Priority 2”).
Priority 5: Hs and Ts Address reversible causes of cardiac arrest in parallel
with priorities 14.
Additional treatment options include:
IV fluids
Rewarming
Medications: e.g., calcium chloride, thrombolytics, naloxone, 8.4% NaHCO3
Procedures: e.g., needle thoracostomy, pericardiocentesis, PCI, advanced
airway device placement Endpoints ROSC identified during rhythm and
pulse check: Begin postresuscitation care.
Termination of resuscitation decision is made: Follow procedure for
declaration of death.