ACLS — Adult Cardiac Arrest
Source: AHA Guidelines for CPR & ECC 2025 · Last reviewed: Jul 2026
Patient unresponsive & not breathing normally → start CPR, give oxygen, attach monitor/defibrillator.
Shockable rhythm? (VF / pVT)
Yes — VF / pVT (shockable)
Single defibrillation (one shock, not stacked) → resume CPR immediately, no pause to check pulse/rhythm.
- Dose: 360 Joules for Monophasic, or 200 Joules for Biphasic.
CPR 2 minutes + IV/IO access. Give epinephrine after the initial defibrillation attempt has failed.
If VF/pVT persists after several shocks (persisting VF/pVT):
- Epinephrine every 3–5 minutes
- Consider amiodarone or lidocaine
- Consider advanced airway + capnography
No — Asystole / PEA (non-shockable)
CPR 2 minutes + IV/IO access. Give epinephrine as soon as possible.
Epinephrine every 3–5 minutes. Consider advanced airway + capnography. Identify & treat reversible causes.
Return of Spontaneous Circulation (ROSC)? — palpable pulse, sudden EtCO₂ rise (usually ≥40 mmHg), or spontaneous arterial waveform.
Yes → post-cardiac arrest care, target MAP ≥65 mmHg, avoid hypotension. No → continue the CPR cycle above.
Reversible Causes (H's & T's)
Quick Dose Reference
| Drug | Dose | Notes |
|---|---|---|
| Epinephrine | 1 mg IV/IO every 3–5 min | Non-shockable: give ASAP. Shockable: after failed initial shock. |
| Amiodarone | 300 mg bolus, 2nd dose: 150 mg | For refractory VF/pVT |
| Lidocaine | 1–1.5 mg/kg, 2nd dose: 0.5–0.75 mg/kg | Alternative if amiodarone unavailable |