Overview

The initial approach to cardiac arrest is influenced by the rescuers (e.g., number of rescuers, training received), patient factors (e.g., age, pregnancy), and location (i.e., in-hospital vs. out-of-hospital).

• Identify cardiac arrest and initiate an emergency response.

• Begin BLS (i.e., immediate CPR, especially chest compressions).

• Defibrillate shockable rhythms.

• Transition care to ACLS providers.

• Initiate postresuscitation care.

• Provide comprehensive support throughout recovery.

• For sudden cardiac arrest, use the CAB approach to begin chest compression as soon as possible.

  1. Chest compressions

  2. Airway

  3. Breathing

• Prioritize airway and breathing (i.e., ABC approach) for cardiac arrest secondary to respiratory arrest.

• Minimize interruptions to CPR.

• If the diagnosis of cardiac arrest is uncertain, initiating CPR is preferable to withholding CPR.

• Key targets for high-quality chest compressions

  • Compression rate: 100–120 per minute

  • Compression depth for adults: 5–6 cm (2–2.5 inches)

  • Allow full chest recoil between compressions.

• Provider positioning and technique (adults and children; excluding infants)

  • Kneel or stand next to the patient depending on whether they are on the ground or in a bed, respectively.

  • Center the hands (one on top of the other, fingers interlaced) over the sternum.

  • Keep the arms straight (do not bend the elbows); the shoulders should be directly above the hands.

  • Use full body weight to deliver rapid, firm compressions.

• Patient positioning: supine on a firm surface

• Minimizing interruptions

  • Restart CPR between rhythm analysis and shock delivery (while the defibrillator is charging).

  • Resume CPR immediately after shock delivery.

• Mouth-to-mouth

  1. Open the airway using the head-tilt/chin-lift maneuver.

  2. Pinch the patient's nose closed.

  3. Form a tight seal over the patient's mouth.

  4. Breathe slowly into the patient's mouth for ∼ 1 second; check for chest rise to confirm sufficient ventilation.

  5. Move away from the patient's mouth between breaths to allow air to escape, ensuring the patient's airway remains open.

• If equipment is available: Ventilate with 100% O2; select a modality based on patient factors and provider expertise.

  • BMV: Administer 2 breaths after every 30 chest compressions.

  • Advanced airway

    • Maintain an uninterrupted rate of 10 breaths/minute.

    • Do not interrupt CPR for > 10 seconds to facilitate placement of an advanced airway.

    • Return to BMV if an advanced airway has not been secured within 10 seconds.