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For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 7, Cardiac Arrest.



  • imageHigh-quality cardiopulmonary resuscitation with minimal interruptions in chest compressions should be delivered to all patients following cardiac arrest.

  • imageThe AHA algorithm for basic life support emphasizes circulation, airway, and breathing, forming the mnemonic “CAB."

  • imageThe purpose of using vasopressor therapy following cardiac arrest is to augment coronary and cerebral perfusion pressures.

  • imageVasopressin appears to offer no benefit as a substitute for epinephrine.

  • imageSuccessful treatment of both pulseless electrical activity (PEA) and asystole depends on determining the underlying cause.

  • imageIntraosseous administration is the preferred alternative route when IV access cannot be achieved.


Patient Care Process for Cardiac Arrest



  • Patient characteristics (eg, sex, age)

  • Patient medical history (if available)

  • Current and past medications that could have contributed to the arrest or serve as a clue to the underlying medical history

  • Objective data

    • Presence of a pulse

    • Cardiac rhythm


  • Is the patient responsive?

  • Is there a pulse present?

  • Are the ECG leads correctly placed on the patient?

  • Is the rhythm shockable?


  • Activate EMS and obtain an AED if one is nearby (for out-of-hospital arrest)

  • Call for “code blue” and obtain crash cart (for in-hospital arrest)

  • Immediately begin chest compressions and follow BLS algorithm

  • Administer electrical therapy (ie, defibrillation) if indicated

  • Drug therapy per advanced cardiac life support (ACLS) algorithm if indicated

  • Monitor for the return of spontaneous circulation, cardiac rhythm, and pulse


  • Perform high-quality chest compressions with minimal interruptions

  • Administer defibrillations and drug therapy as indicated by cardiac rhythm

Follow-up: Monitor and Evaluate*

  • Monitor end-tidal CO2 as an indicator of CPR quality

  • Implement postresuscitative care plan consisting of therapeutic hypothermia if indicated

  • ECG and PCI when an acute coronary syndrome is suspected

  • Review patient history for identification of other contributors or underlying cause of the arrest

  • Diligent monitoring of blood pressure, oxygen saturation, temperature, urine output, and glucose

  • Evaluate and monitor for seizure

*Collaborate with patient, caregivers, and other healthcare professionals.


Preclass Engaged Learning Activity

Review the American Heart Association (AHA) algorithms for BLS and ACLS. Create a table which lists the medications that are recommended in the guidelines that might be used, when they might be used, and what the intended purpose of their use is. All guidelines for cardiopulmonary resuscitation and emergency cardiac care can be found at


Cardiac arrest is defined as the cessation of cardiac mechanical activity as confirmed by the absence of signs of circulation (eg, a detectable pulse, unresponsiveness, and apnea).1 While there is wide variation in the reported incidence of cardiac arrest, it is estimated that there are ...

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