Two minute cycles, rhythm check, and the shockable or non-shockable arms
Expansion
The cycle: CPR for 2 minutes, then a rhythm check, then repeat. Minimise interruptions to compressions.
Compressions: depth 5 to 6 cm, rate 100 to 120 per minute, ratio 30:2 until the airway is secured, then continuous compressions with ventilation at 10 per minute.
Shockable (VF or pulseless VT)
- Shock immediately, then resume CPR for 2 minutes
- Second shock, CPR
- Third shock, then adrenaline 1 mg and amiodarone 300 mg
- Adrenaline every 3 to 5 minutes, and a further amiodarone 150 mg after the fifth shock
Non-shockable (PEA or asystole)
- Adrenaline 1 mg immediately, then every 3 to 5 minutes
- CPR, rhythm check every 2 minutes. No amiodarone
Throughout: high quality compressions, oxygen, waveform capnography, vascular access, and correct the four Hs and four Ts.
Capnography is the most useful monitor: it confirms tube placement, indicates compression quality, and a sudden rise suggests return of spontaneous circulation. A persistently low end tidal carbon dioxide below about 1.3 kPa after 20 minutes suggests a poor outcome.