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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Cardiac arrest and post-resuscitation care

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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An unresponsive adult with abnormal breathing is presumed to be in cardiac arrest: call 999/2222, start high-quality CPR and attach an AED/defibrillator immediately. Continue ALS until ROSC, a senior team decision to stop, or transfer to an extracorporeal pathway in selected cases.

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.
  • For shockable arrest, give adrenaline 1 mg and amiodarone 300 mg after the third shock; repeat adrenaline every 3–5 minutes and give amiodarone 150 mg after the fifth shock.
  • For PEA/asystole, give adrenaline 1 mg as soon as possible, repeat every 3–5 minutes and aggressively search for reversible causes.
  • Do not routinely give calcium, sodium bicarbonate, corticosteroids or fluid; fluid is for hypovolaemic arrest and thrombolysis is considered when PE is suspected/confirmed.
  • After ROSC, initially use 100% oxygen only until saturation is reliable, then titrate to SpO2 94–98% and target PaCO2 4.7–6.0 kPa; avoid hypoxaemia, hyperoxaemia and hypocapnia.
  • In comatose survivors actively prevent fever at ≤37.5°C, investigate the cause, and delay final poor-outcome conclusions until multimodal assessment at least 72 hours after ROSC without confounders.

    • Key red flags

    Cardiac-arrest breathing

    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.

    Shockable rhythm

    VF or pulseless VT requires immediate defibrillation with CPR resumed straight after each shock.

    Non-shockable rhythm

    PEA or asystole requires immediate CPR, early adrenaline and cause treatment; confirm true asystole and check leads/gain.

    Reversible cause

    Hypoxia, hypovolaemia, electrolyte/metabolic disorder, hypothermia, thrombosis, tamponade, tension pneumothorax and toxins are sought and treated without stopping CPR unnecessarily.

    Investigation priorities

    01
    Defibrillator rhythm analysis every 2 minutesFirst step

    Separate VF/pVT from PEA/asystole and time shocks/drugs.

    Management branches

    First-lineBLS and defibrillator

    Unresponsive adult with abnormal breathing

    1. Ensure safety, call 999 or the hospital arrest number 2222, start chest compressions immediately and send for an AED/defibrillator.
    2. Compress 100–120/min to 5–6 cm with full recoil; give 30:2 if trained/able, otherwise continuous compression following dispatcher advice.
    3. Attach the AED as soon as available, follow prompts, deliver an advised shock and resume CPR immediately.
    4. Change compressor before fatigue while minimising every interruption.

    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.Use the cardiac-arrest preparation/concentration and closed-loop documentation. Do not delay CPR/defibrillation or confuse with anaphylaxis dosing.
    Amiodarone (VF/pVT arrest)300 mg IV/IO after a total of three shocks, then 150 mg after a total of five shocks.Does not replace defibrillation or cause correction; timing counts total shocks even if VF/pVT is intermittent.
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    Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
    Sources

    Sources and review status

    National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

    • Resuscitation Council UK 2025 Adult basic life supportRecognition, call, CPR and AED sequence.
    • Resuscitation Council UK 2025 Adult advanced life supportDefibrillation, drugs, airway, reversible causes and ECPR.
    • Resuscitation Council UK 2025 Post-resuscitation careOxygen, coronary, temperature, neurological and rehabilitation care.
    • Resuscitation Council UK 2025 Special circumstancesPE arrest, prolonged CPR and special-cause modifications.

    Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

    Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom