What is the American Heart Association (AHA) adult cardiac arrest algorithm for CPR and ACLS in ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT)?

Updated: Sep 15, 2020
  • Author: Catharine A Bon, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Answer

Answer

The following summarizes the AHA adult cardiac arrest algorithm for ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) [43]

  • Activate emergency response system
  • Initiate CPR and give oxygen when available
  • Verify patient is in VF as soon as possible (ie, AED or quick look with paddles)
  • Defibrillate once: Use a device-specific recommendation (ie, 120-200 J for biphasic waveform and 360 J for monophasic waveform); if unknown, use the maximum available
  • Resume CPR immediately without pulse check and continue for five cycles. One cycle of CPR equals 30 compressions and two breaths; five cycles of CPR should take roughly 2 minutes (compression rate 100 per minute); do not check for rhythm/pulse until five cycles of CPR are completed.
  • During CPR, minimize interruptions while securing intravenous (IV) access and performing endotracheal intubation. Once the patient is intubated, continue CPR at 100 compressions per minute without pauses for respirations, and administer respirations at 10 breaths per minute.
  • Check rhythm after 2 minutes of CPR.
  • Repeat a single defibrillation if the patient is still in VF/pVT with rhythm check. Selection of fixed versus escalating energy for subsequent shocks is based on the specific manufacturer’s instructions. For a manual defibrillator capable of escalating energies, higher energy for the second and subsequent shocks may be considered.

  • Resume CPR for 2 minutes immediately after defibrillation.

  • Continuously repeat the cycle of (1) rhythm check, (2) defibrillation, and (3) 2 minutes of CPR
  • Administer epinephrine,1 mg every 3–5 minutes during CPR, before or after shock, when IV or intraosseous (IO) access is available (Note that vasopressin has not been shown to have benefit in addition to epinephrine, so for simplicity it has been removed from the algorithm for most cases.)
  • Administer amiodarone 300 mg IV/IO once, if dysrhythmic during CPR, before or after shock; then consider administering an additional 150 mg once.

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