Synopsis
Deliver coordinated adult cardiac-arrest care by recognising arrest promptly, maintaining effective compressions and ventilation, treating the rhythm and reversible causes, and supporting recovery.
- Call 999 immediately for an unresponsive person in the community, assessing breathing while the call connects.
- Compress the lower half of the sternum at 100–120/min to a depth of 5–6 cm, allowing full recoil.
- Use 30:2 until an effective tracheal tube or supraglottic airway permits continuous compressions with 10 breaths/min; return to 30:2 if supraglottic leakage prevents adequate ventilation.
Investigation priorities
Select the electrical pathway with minimal interruption of compressions.
Management branches
A monitored adult collapses into VF and remains pulseless despite three appropriately delivered shocks separated by two-minute CPR cycles.
- Resume compressions immediately after the third shock and check that pad placement, skin contact and delivered energy are appropriate; do not wait to inspect whether a pulse has appeared.
- Administer adrenaline 1 mg IV and amiodarone 300 mg IV while CPR continues, assigning one team member to record total shocks and administration times.
Key medicines
Adrenaline during adult cardiac arrestGive 1 mg IV promptly for a non-shockable rhythm or after the third shock for VF/pVT; repeat every 3–5 minutes while ALS continues. Use IO when suitable IV access cannot be rapidly obtained.This cardiac-arrest regimen must not be confused with the 500 microgram IM anaphylaxis regimen in a patient with a circulation. Record dose timing to avoid duplication.
Amiodarone for shock-refractory VF or pulseless VTGive 300 mg IV after three total shocks and a further 150 mg IV after five total shocks if VF/pVT persists or recurs during the arrest.Do not give it routinely for asystole or PEA. Drug administration must not defer the next required shock or interrupt effective chest compressions.