Cardiac arrest is the sudden cessation of cardiac activity where the victim becomes unresponsive with no breathing or pulse. There are two main types of cardiac arrest rhythms - shockable rhythms including ventricular fibrillation and pulseless ventricular tachycardia, and non-shockable rhythms such as asystole and pulseless electrical activity. For shockable rhythms, the protocol is to give a shock, then perform CPR for 2 minutes before reassessing the rhythm. For non-shockable rhythms like asystole, the protocol is to perform CPR for 2 minutes and then give epinephrine every 3-5 minutes without interrupting CPR.

1. Management of Cardiac Arrest

2. Objectives:
After the completion of this session the participants
will be able to:
• Define cardiac arrest
• List reversible causes of cardiac arrest
• Identify shockable and non-shockable rhythms
• Manage cardiac arrest

3. “Cardiac arrest is the sudden cessation
of cardiac activity so that the victim
becomes unresponsive with no normal
breathing and no signs of circulation”
–American Heart Association and American
College of Cardiology

4. Reversible causes of cardiac arrest
The 6 “Hs” The 6 “Ts”
Hypovolemia Tension pneumothorax
Hypoxia Tamponade
H+ (Acidosis) Toxins
Hypo/Hyperkalemia Thrombosis (coronary)
Hypoglycemia Thrombosis (pulmonary
Hypothermia Trauma

5. Types of cardiac arrest rhythm
Four cardiac arrest rhythms, divided into 2
groups.
oShockable
Ventricular fibrillation
Pulseless ventricular tachycardia
oNon-shockable
Asystole
Pulseless electrical activity

6. Asystole
• Most common, life-threatening non-shockable cardiac
rhythm
• Absence of electrical and mechanical cardiac activity
• Flat line in the ECG
• P-waves may be seen occasionally
• No visible cardiac activity
• Occurs after prolonged hypoxia and acidosis:
Leading to bradycardia and then asystole.

7. Pulseless electrical activity (PEA)
• PEA is a waveform cardiac rhythm on ECG
• But without a detectable pulse.
• Non-shockable rhythm.
• Pre-asystole state.
• Management similar to Asystole.

8. Ventricular fibrillation (VF)
• VF is a life-threatening condition.
• Ineffective ventricular contractions
• Chaotic disorganized series of depolarisations not
synchronized with atrial contraction
• Shockable rhythm.

9. Pulseless Ventricular tachycardia
• Broad complex regular rhythm
• Fast rate
• Constant QRS morphology
• Shockable rhythm.

10. Cardiac Arrest Algorithm
Rhythm
VF/PVT PEA/ASYSTOLE
Non- Shockable
Shockable
Give shock 2J/Kg
CPR for 2 minutes
• Give shock.
• Adrenaline 10mcg/kg after
2nd shock
• Amiadarone 5mg/kg after 3rd
shock
Assess rhythm
Start CPR
Give oxygen
Attach ECG monitor/defibrillator
Shockable

11. PEA/ Asystole
• CPR for 2 minutes
• IV/IO access
• Adrenaline every 3- 5 minutes without interruption of CPR
• Consider advanced airway
Shockable rhythm
 CPR for 2 minutes
 Treat treatable causes
ON
VF Protocol
YES

12. Energy for shock:
• First shock: 2 J/kg
• Second shock: 4 J/kg
• Subsequent shocks: ≥ 4 J/kg
• Maximum dose of the shock: 10 J/kg or adult dose
Drug Therapy:
• Adrenaline (Epinephrine) IV/IO dose: 0.01 mg/kg
(Repeat every 3 to 5 minutes; if no IO/IV access, may be
given via an endotracheal route: 0.1 mg/kg)
• Amiodarone IV/IO dose: 5mg/kg bolus during cardiac
arrest (May repeat up to two times for refractory
VF/pulseless VT)

13. Questions?

14. Summary
• Give two examples of shockable and non-
shockable rhythms
• How do you manage asystole?

15. Thank You