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Adult Cardiac Arrest Circular Algorithm (ACLS): CPR, Shocks, Drugs, Airway & ROSC
ACLS • Resuscitation • Educational

Adult Cardiac Arrest Circular Algorithm

A fast walkthrough of the circular algorithm: start CPR, check rhythm, shock for VF/pVT, dose epinephrine and amiodarone/lidocaine, consider an advanced airway, and treat reversible Hs & Ts on every cycle until ROSC.

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Educational content only—follow current guidelines and local protocols; consult a licensed clinician.

In this guide:
Start CPR The 2-Minute Loop CPR Quality Shock Energy Drug Therapy Advanced Airway ROSC Reversible Causes (Hs & Ts) Cited Keywords

Start CPR & Attach Monitor/Defibrillator

  • Give oxygen and begin compressions immediately.
  • Assess rhythm quickly: if VF/pVT, shock; if asystole/PEA, resume CPR and give epinephrine.
Rotate compressors every 2 minutes and minimize pauses.

The 2-Minute Circular Loop

Core Actions (every cycle)

  1. Check rhythm ➜ shock if VF/pVT; otherwise continue CPR.
  2. Drug therapy: epinephrine q 3–5 min; add amiodarone/lidocaine for refractory VF/pVT.
  3. Consider advanced airway with waveform capnography.
  4. Treat reversible causes (Hs & Ts).
  5. Monitor and improve CPR quality continuously.

CPR Quality: What to Aim For

  • Depth at least 5 cm (2 in); rate 100–120/min; allow full recoil.
  • Minimize interruptions; avoid hyperventilation.
  • Change compressor every 2 min or sooner if fatigued.
  • Use quantitative waveform capnography—falling ETCO₂ prompts quality check and search for causes.

Shock Energy

  • Biphasic: Use the manufacturer’s recommended initial dose (often ~120–200 J) and escalate; subsequent doses should be equivalent or higher.
  • Monophasic: Use 360 J for subsequent shocks.
Technique tip: Charge during compressions and shock within seconds of the rhythm check.

Drug Therapy

Epinephrine (IV/IO)

  • 1 mg every 3–5 minutes throughout arrest (both shockable and non-shockable pathways).

Antiarrhythmics (for VF/pVT)

  • Amiodarone: 1st dose 300 mg bolus; 2nd dose 150 mg.
  • or Lidocaine: 1st dose ~1–1.5 mg/kg; 2nd dose ~0.5–0.75 mg/kg.

Use your local formulary and protocols for exact dosing rules and contraindications.

Advanced Airway & Ventilation

  • Endotracheal tube or supraglottic airway when indicated; confirm with waveform capnography.
  • After securing an airway, ventilate ~1 breath every 6 sec with continuous compressions.

Return of Spontaneous Circulation (ROSC)

  • Check for pulse and blood pressure; abrupt rise in ETCO₂ can signal ROSC.
  • Optimize oxygenation/ventilation, treat hypotension, obtain 12-lead ECG, and start post–cardiac arrest care.

Reversible Causes (Hs & Ts)

Hs

  • Hypovolemia
  • Hypoxia
  • Hydrogen ion (acidosis)
  • Hypo-/Hyperkalemia
  • Hypothermia
  • Hypoglycemia (consider)

Ts

  • Tension pneumothorax
  • Cardiac tamponade
  • Toxins
  • Thrombosis (pulmonary)
  • Thrombosis (coronary)
Why it matters: Fixing an H or T can be the turning point for ROSC—keep checking every cycle.

Cited Keywords & Referral Links

Each keyword links to the main website or a related post on gyathshammha.com.

ACLS Cardiac arrest CPR Defibrillation Epinephrine Amiodarone Lidocaine Advanced airway Capnography ROSC Hs & Ts Related education post

Bottom line

Run the circular loop with discipline: high-quality CPR, quick rhythm checks with immediate shocks for VF/pVT, timely epinephrine and antiarrhythmics, airway when appropriate, and relentless Hs & Ts search—until ROSC or the plan changes.

This guide summarizes common teaching points and is not a substitute for up-to-date guidelines or clinical judgment.

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