Adults

Cardiac Arrest – Asystole/PEA

Diagnosis

Non-shockable pulseless cardiac arrest

Diagnosis

Non-shockable pulseless cardiac arrest

  1. Call for help and a code cart

    • Ask: "Who will be the crisis manager?"
    • Say: "The top priority is high-quality CPR"
    • Crisis manager assigns roles - see ROLE assignments box

  2. Put backboard under patient

    • Turn supine as soon as possible, but do not delay the start of compressions

  3. Turn FiO2 to 100%, turn off volatile anesthetic

  4. Start CPR and assessment cycle

    • Perform CPR
      • “Hard and fast” about 100-120 compressions/min to depth ≥2 inches
      • Ensure full chest recoil with minimal interruptions
      • 10 breaths/minute, do no over-ventilate
        • Bag-mask ventilation until able to place endotracheal tube
    • Give EPINEPHrine 1mg IV
      • Repeat EPINEPHrine every 3-5 minutes
    • Assess every 2 minutes (limit assessment to <10 seconds)
      • Change CPR compression provider
      • Check ETCO2
        • If: <10 mmHg, evaluate CPR technique
        • If: Sudden increase to >40 mmHg, may indicate return of spontaneous circulation
      • Check rhythm
        • If: Asystole/PEA continues:
          • Resume CPR and assessment cycle (restart Step 4)
          • Treat reversible causes, consider reading aloud differential diagnoses
        • If: VF / VT
    • 1 mg IV, repeat every 3 - 5 minutes

  5. Consider ECMO if refractory cardiac arrest

Patient weight

Between 30 kg and 250 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.