CPR QUALITY ADVANCED AIRWAY • Push hard (at least 2 inches [5 cm]) and fast (100-120/min) and allow • Endotracheal intubation or supraglottic advanced airway complete chest recoil. • Waveform capnography or canometry to confirm and monitor ET • Minimize interruptions in compressions. tube placement • Avoid excessive ventilation. • Once advanced airway in place, give 1 breath every 6 seconds (10- • Rotate compressor every 2 minutes, or sooner if fatigued. 12 breaths/min) with continuous chest compressions • If no advanced airway, 30:2 compression-ventilation ratio. • Quantitative waveform capnography o If PETCO2 <10mm HG, attempt to improve CPR quality RETURN OF SPONTANEOUS CIRCULATION (ROSC) • Intra-arterial pressure o If relaxation phase (diastolic) pressure <20 mm Hg, • Pulse and blood pressure attempt to improve CPR quality • Abrupt sustained increase in PETCO2 (typically ≥40mm Hg) • Spontaneous arterial pressure waves with intra-arterial monitoring SHOCK ENERGY FOR DEFIBRILLATION • Biphasic: Manufacturer recommendation (eg, initial dose of 120-200 REVERSIBLE CAUSES J); if unknown, use maximum available. Second and subsequent doses should be equivalent, and higher doses may be considered. H’s T’s • Monophasic: 360 J • Hypovolemia • Tension pneumothorax • Hypoxia • Tamponade (cardiac) DRUG THERAPY • Hydrogen ion (acidosis) • Toxins • Epinephrine IV/IO Dose: 1 mg every 3-5 minutes • Hypo-/hyperkalemia • Thrombosis (pulmonary) • Amiodarone IV/IO Dose: First dose: 300mg bolus. Second dose: • Hypothermia • Thrombosis (coronary) 150mg.
This Algorithm is based on the latest (2015) American Heart Association standards and guidelines.
