¹ CPR quality:
• Push hard (≥5 cm/2 inches) and fast (100-120/min), allow complete chest recoil
• Minimize interruptions in compressions
• Avoid excessive ventilation
• Change compressor q2min, or sooner if fatigued
• If no advanced airway, 30:2 compression:ventilation ratio
• Quantitative waveform capnography: If PETCO₂ low/decreasing, reassess CPR quality

² Shock energy for defibrillation:
• Biphasic: Use mfr-recommended energy level (120-200 J), or if unknown, use maximum available; subsequent shocks at same energy level, or consider higher
• Monophasic: 360 J

³ Drug therapy:
• epinephrine IV/IO dose: 1 mg q3-5min
• amiodarone IV/IO dose: First dose: 300 mg bolus. Second dose: 150 mg
• lidocaine IV/IO dose: First dose: 1-1.5 mg/kg. Second dose: 0.5-0.75 mg/kg

⁴ Advanced airway:
• Endotracheal intubation or supraglottic advanced airway
• Waveform capnography or capnometry to confirm/monitor ET tube placement
• Once advanced airway in place, give 1 breath q6sec (10/min) w/ continuous chest compressions

⁵ Reversible causes:
• Hypovolemia
• Hypoxia
• Hydrogen ion (acidosis)
• Hypo/hyper-kalemia
• Hypothermia
• Tension pneumothorax
• Tamponade, cardiac
• Toxins
• Thrombosis, pulmonary
• Thrombosis, coronary

⁶ Return of spontaneous circulation (ROSC) signs:
• Pulse & BP
• Abrupt sustained increase in PETCO (typically ≥40 mm Hg)
• Spontaneous arterial pressure waves w/ intra-arterial monitoring

¹ CPR quality:
• Push hard (≥5 cm/2 inches) and fast (100-120/min), allow complete chest recoil
• Minimize interruptions in compressions
• Avoid excessive ventilation
• Change compressor q2min, or sooner if fatigued
• If no advanced airway, 30:2 compression:ventilation ratio
• Quantitative waveform capnography: If PETCO₂ <10 mmHg, attempt to improve CPR quality
• Intra-arterial pressure: If relaxation phase (diastolic) pressure <20 mmHg, attempt to improve CPR

² epinephrine IV/IO dose: 1 mg q3-5min

³ Advanced airway:
• Endotracheal intubation or supraglottic advanced airway
• Waveform capnography or capnometry to confirm/monitor ET tube placement
• Once advanced airway in place, give 1 breath q6sec (10/min) w/ continuous chest compressions

⁴ Reversible causes:
• Hypovolemia
• Hypoxia
• Hydrogen ion (acidosis)
• Hypo/hyper-kalemia
• Hypothermia
• Tension pneumothorax
• Tamponade, cardiac
• Toxins
• Thrombosis, pulmonary
• Thrombosis, coronary

⁵ Return of spontaneous circulation (ROSC) signs:
• Pulse and BP
• Abrupt sustained increase in PETCO2 (typically ≥40 mm Hg)
• Spontaneous arterial pressure waves w/ intra-arterial monitoring

¹ Causes:
• myocardial ischemia/infarction
• drugs/toxicologic (eg calcium-channel blockers, beta blockers, digoxin)
• hypoxia
• electrolyte abnormality (eg, hyperkalemia)

² Drug therapy:

Atropine IV Dose:
• first dose: 1 mg bolus
• repeat q3-5min
• max: 3 mg

Dopamine IV Infusion:
• usual infusion rate is 5-20 mcg/kg per min
• titrate to pt response; taper slowly

Epinephrine IV Infusion:
• 2-10 mcg per min infusion
• titrate to pt response

¹ Clinical considerations:
• Xxx
• Xxx
• Xxx

² Adenosine IV Dose:
• First dose: 6 mg rapid IV push; follow w/ NS flush
• Second dose: 12 mg (if required)

³ Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia:

Procainamide IV Dose:
• 20-50 mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases >50%, or max dose 17 mg/kg given
• Maintenance infusion: 1-4 mg/min
• Avoid if prolonged QT or CHF

Amiodarone IV Dose:
• First dose: 150 mg over 10min
• Repeat as needed if VT recurs
• Follow by maintenance infusion: 1 mg/min for first 6h

Sotalol IV Dose:
• 100 mg (1.5 mg/kg) over 5min
• Avoid if prolonged QT

⁴ Synchronized Cardioversion, Initial Recommended Doses:
• Refer to your specific device's recommended energy level to maximize first shock success.

¹ Initial Stabilization Phase

Resuscitation is ongoing during the post-ROSC phase, and many of these activities can occur concurrently. However, if prioritization is necessary, follow these steps:

• Airway management: Waveform capnography/capnometry to confirm & monitor endotracheal tube placement
• Manage respiratory parameters: Titrate FIO₂, for SpO₂ 92%-98%; start at 10 breaths/min; titrate to PaCO₂ of 35-45 mm Hg
• Manage hemodynamic parameters: Administer crystalloid and/or vasopressor or inotrope for goal systolic BP >90 mm Hg or mean arterial pressure >65 mm Hg

² Continued Management & Additional Emergent Activities

These evals should be done concurrently so that decisions on targeted temperature management (TTM) receive as high priority as cardiac interventions:

• Emergent cardiac intervention: Early eval of 12-lead electrocardiogram (ECG); consider hemodynamics for decision on cardiac intervention
• TTM: If pt is not following commands, start TTM ASAP: Begin at 32-36°C for 24h by using a cooling device w/ feedback loop
• Other critical care management:
- continuously monitor core temp (esophageal, rectal, bladder)
- maintain normoxia, normocapnia, euglycemia
- provide continuous or intermittent electroencephalogram (EEG) monitoring
- provide lung-protection ventilation

³ Reversible Causes (Hs & Ts):
• Hypovolemia
• Hypoxia
• Hydrogen ion (acidosis)
• Hypo/hyper-kalemia
• Hypothermia
• Tension pneumothorax
• Tamponade, cardiac
• Toxins
• Thrombosis, pulmonary
• Thrombosis, coronary