Cardiac arrest- ALS- 2021

Last Updated on by frcemuser

  • start CPR immediately, and defibrillate rapidly (<3 minutes) when appropriate.
  • Place pads – Antero-lateral (lateral – Mid-axillary line) pad position. In patients with an implantable device Place the pad > 8 cm away from the device, or use an alternative pad position
  • Shockable :
    • The use of up to three-stacked shocks may be considered only if initial ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT).
    • Give a shock as early as possible ( Energy ranging from 120-360 J-Followed by a fixed or escalating strategy up to the maximum output of the defibrillator) followed by a 2-minute cycle of chest compressions.
    • Continue chest compressions during defibrillator charging
    • delivering defibrillation with an interruption in chest compressions of less than 5 seconds
    • Immediately resume chest compressions after shock delivery
    • Give adrenaline 1 mg IV (IO) after the 3rd shock for adult patients in cardiac arrest with a shockable rhythm.
    • Repeat adrenaline 1 mg IV (IO) every 3-5 minutes whilst ALS continues.
    • Give amiodarone 300 mg IV (IO) for adult patients in cardiac arrest who are in VF/pVT after three shocks
    • Give a further dose of amiodarone 150 mg IV (IO) for adult patients in cardiac arrest who are in VF/pVT after five shocks
    • Lidocaine 100 mg IV (IO) may be used as an alternative if amiodarone is not available. An additional bolus of lidocaine 50 mg can also be given after five defibrillation attempts.
    • Recurrent or refractory VF
      • Consider escalating the shock energy,
      • consider using an alternative defibrillation pad position (e.g. anterior-posterior).
  • Non-shockable rhythm
    • Give adrenaline 1 mg IV (IO) as soon as possible
    • Repeat adrenaline 1 mg IV (IO) every 3-5 minutes whilst ALS continues.
  • signs of the return of spontaneous circulation (ROSC) – waking, purposeful movement, arterial waveform or a sharp rise in end-tidal carbon dioxide (ETCO2)
  • Once a tracheal tube or a supraglottic airway (SGA) has been inserted, ventilate the lungs at a rate of 10 minand continue chest compressions without pausing during ventilation ( if  SGA gas leakage – Inadequate ventilation then 30:2)
  • Attempt intravenous (IV) access first to enable drug delivery if, attempts at IV access are unsuccessful or IV access is not feasible try IO
  • Consider reversible  causes H and T :
    • Thrombolytic drugs -when pulmonary embolus is suspected or confirmed. Consider CPR for 60-90 minutes after administration of thrombolytic drugs
    • Fluids-Give IV (IO) fluids only where the cardiac arrest is caused by or possibly caused by hypovolemia.
  • use of Capnography capnography
    •  to confirm correct tracheal tube placement during CPR.
    • to monitor the quality of CPR.
    • An increase in ETCO2 during CPR may indicate that ROSC has occurred
  • the use of POCUS,
    • POCUS must not cause additional or prolonged interruptions in chest compressions.
    • POCUS may be useful to diagnose treatable causes of cardiac arrest such as cardiac tamponade and pneumothorax.
    • Right ventricular dilation in isolation during cardiac arrest should not be used to diagnose massive pulmonary embolism.
    • Do not use POCUS for assessing contractility of the myocardium as a sole indicator for terminating CPR.

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