CARDIAC ARREST / ASYSTOLE
ALL LEVELS
Designation of Condition
The patient will be unconscious, unresponsive, pulseless, apneic, and show asystole on the monitor (confirmed with a six-second strip) in 3 leads. Patients in cardiac arrest should be managed in the field.
1. Confirm patient is unresponsive, has apneic/agonal respirations and is pulseless.
a. Begin high quality pit crew CPR
b. Apply monitor/AED to confirm rhythm.
c. Consider placement of Supraglottic (LMA preferred), allowing no disruption of chest compressions during placement.
d. Apply EtCO2 and SpO2
e. Check rhythm/pulse every 200 compressions (2 minutes).
AEMT
1. Consider placement of Supraglottic Airway (LMA preferred), allowing no disruption of chest compressions during placement.
2. Establish IV/IO access and administer NS
3. Administer Epinephrine, IV/IO See SPECIAL NOTE below.
4. IV/IO dosage of Epinephrine: (1:10,000) 1 mg every 3-5 minutes as indicated
PARAMEDIC
1. Consider placement of SGA Airway or ETT in accordance with the corresponding Airway Placement Procedural Guidelines, allowing no disruption of chest compressions during placement.
2. If electrical activity returns but patient remains pulseless, proceed to PEA algorithm.
3. If sustained Asystole after 30 minutes consider TOR.
4. If no ROSC and the patient remains in asystole after 30 minutes of ALS resuscitative efforts consider TOR. See Termination of Resuscitation Guidelines.
EPINEPHRINE DOSING IN CARDIAC ARREST SPECIAL NOTES
Shortages of EPINEPHRINE 1:10,000 are necessitating alternate dosing for cardiac arrest patients. EPINEPHRINE administration in cardiac arrest patients is associated with improved ROSC rates but no dosing regimen has been shown to be superior in terms of ultimate survival. The following dosing regimens are acceptable in cardiac arrest patients when EPINEPHRINE 1:10,000 is unavailable or rationed. ET dosing is no longer an approved route.
1. AHA recommended dosing if EPINEPHRINE available: 1 mg. IV/IO q 3-5 minutes. No limitation on number of doses given.
2. EPINEPHRINE 1 mg. q 5-10 minutes IV/IO. No limitation on number of doses given.
3. EPINEPHRINE 1 mg. IV/IO followed by infusion.
a. Infusion: Mix 3 mg. (3 vials of 1 mg. 1:1,000) into a 1,000 cc bag of crystalloid solution and run so that bag is infusing throughout the 30 minute resuscitation.
4. EPINEPHRINE infusion only.
ALL LEVELS
Designation of Condition
The patient will be unconscious, unresponsive, pulseless, apneic, and show asystole on the monitor (confirmed with a six-second strip) in 3 leads. Patients in cardiac arrest should be managed in the field.
1. Confirm patient is unresponsive, has apneic/agonal respirations and is pulseless.
a. Begin high quality pit crew CPR
b. Apply monitor/AED to confirm rhythm.
c. Consider placement of Supraglottic (LMA preferred), allowing no disruption of chest compressions during placement.
d. Apply EtCO2 and SpO2
e. Check rhythm/pulse every 200 compressions (2 minutes).
AEMT
1. Consider placement of Supraglottic Airway (LMA preferred), allowing no disruption of chest compressions during placement.
2. Establish IV/IO access and administer NS
3. Administer Epinephrine, IV/IO See SPECIAL NOTE below.
4. IV/IO dosage of Epinephrine: (1:10,000) 1 mg every 3-5 minutes as indicated
PARAMEDIC
1. Consider placement of SGA Airway or ETT in accordance with the corresponding Airway Placement Procedural Guidelines, allowing no disruption of chest compressions during placement.
2. If electrical activity returns but patient remains pulseless, proceed to PEA algorithm.
3. If sustained Asystole after 30 minutes consider TOR.
4. If no ROSC and the patient remains in asystole after 30 minutes of ALS resuscitative efforts consider TOR. See Termination of Resuscitation Guidelines.
EPINEPHRINE DOSING IN CARDIAC ARREST SPECIAL NOTES
Shortages of EPINEPHRINE 1:10,000 are necessitating alternate dosing for cardiac arrest patients. EPINEPHRINE administration in cardiac arrest patients is associated with improved ROSC rates but no dosing regimen has been shown to be superior in terms of ultimate survival. The following dosing regimens are acceptable in cardiac arrest patients when EPINEPHRINE 1:10,000 is unavailable or rationed. ET dosing is no longer an approved route.
1. AHA recommended dosing if EPINEPHRINE available: 1 mg. IV/IO q 3-5 minutes. No limitation on number of doses given.
2. EPINEPHRINE 1 mg. q 5-10 minutes IV/IO. No limitation on number of doses given.
3. EPINEPHRINE 1 mg. IV/IO followed by infusion.
a. Infusion: Mix 3 mg. (3 vials of 1 mg. 1:1,000) into a 1,000 cc bag of crystalloid solution and run so that bag is infusing throughout the 30 minute resuscitation.
4. EPINEPHRINE infusion only.