Synopsis
Apply the 2025 Resuscitation Council UK adult BLS/ALS sequence, treat reversible causes and deliver structured post-ROSC oxygen, coronary, temperature, neurological and rehabilitation care.
- Agonal gasps, slow laboured breathing and brief seizure-like activity can be cardiac arrest; if unresponsive and not breathing normally, assume arrest and start CPR.
- Compress the lower half of the sternum at 100–120/min to 5–6 cm with full recoil and minimal pauses; use 30:2 until an advanced airway permits continuous compressions with 10 breaths/min.
- Defibrillate VF/pulseless VT early, resume CPR immediately for 2 minutes and keep peri-shock pauses under 5 seconds; the first biphasic shock is at least 150 J unless device guidance differs.
Key red flags
Unresponsiveness plus absent or abnormal breathing—including gasping or slow laboured breaths—means start CPR; do not wait for cyanosis or a lay pulse check.
Investigation priorities
Separate VF/pVT from PEA/asystole and time shocks/drugs.
Management branches
Unresponsive adult with abnormal breathing
- Ensure safety, call 999 or the hospital arrest number 2222, start chest compressions immediately and send for an AED/defibrillator.
- Compress 100–120/min to 5–6 cm with full recoil; give 30:2 if trained/able, otherwise continuous compression following dispatcher advice.
Key medicines
Adrenaline (cardiac arrest)1 mg IV/IO as soon as possible for PEA/asystole, or after the third shock for VF/pVT; repeat 1 mg every 3–5 minutes while ALS continues.
Amiodarone (VF/pVT arrest)300 mg IV/IO after a total of three shocks, then 150 mg after a total of five shocks.