Inclusion Criteria: These guidelines will help establish treatment priorities for all apneic and pulseless patients. Do not attempt resuscitation in patients who meet criteria outlined in the Determination of Death Policy or the Do Not Resuscitate Policy. The Neonatal Care guideline covers cardiac arrest in newborns or neonates. Other guidelines may also apply including Asystole, PEA, Trauma, and Ventricular Fibrillation/Pulseless Ventricular Tachycardia.
- Assess for signs of responsiveness and signs of circulation (no more than 5-10 seconds for pulse check).
If the pulse is absent or if you are uncertain, begin high-quality chest compressions.
Push hard at a rate of 100 compressions per minute. Turn on metronome, if available
b. Allow maximum recoil of the chest after each compression.
c. Minimize interruptions in compression.
d. Avoid pausing compressions for more than 10 seconds if at all possible
- Perform CPR at a ratio of
Adults and Children age 8 or older
Infants and Children Younger than age 8
- Assess and support an open airway with head-tilt chin-lift maneuver and an oropharyngeal airway.
a. If you suspect spinal injury, use the jaw thrust maneuver and an oropharyngeal airway.
- Assess and support breathing.
a. Support ventilations with 100% oxygen, 1-hand squeezes of the BVM over 1 second each, and
only enough tidal volume to produce visible chest rise.
b. DO NOT over-ventilate.
c. Use the compression-to-ventilation ratio as specified by age (above).
- For cardiac arrest in cases of suspected trauma, initiate spinal movement restrictions.
a. BLS agencies should begin transport if transfer to the closest appropriate medical facility is faster
than waiting for an ALS unit. Minimize scene time and continue treatment guidelines en route.
b. Contact BioTel as early as possible so that they can notify the receiving Trauma Center who can
begin preparation for the patient’s arrival.
- As soon as a defibrillator or AED arrives, apply hands-free defibrillation pads without interrupting
CPR. For manual defibrillators, use pediatric defibrillation pads (if available) for patients up to 8
years old. For AEDs, use special pediatric dose-attenuating AED pads for patients between 1 and
8 years old. Do not apply the AED to infants under 1 year old. If using a manual defibrillator,
perform all care while in the PADDLES mode.
• If using an AED, follow all voice and visual prompts. Continue defibrillation and CPR sequence until
advanced providers place the patient on a manual defibrillator.
• If using a manual defibrillator, deliver one countershock at a time, if needed for VF or pVT.
• Do not place manual defibrillators in the AED mode:
o Unless specifically permitted by Medical Direction and agency MOP for adults.
o At any time for children younger than the 8th birthday.
• Immediately after delivering a shock, resume high quality chest compressions for 2 full minutes
without first checking the rhythm or pulse.
• At the end of the 2-minute CPR cycle, briefly pause chest compressions for no more than 10 seconds
to check the rhythm.
o If the rhythm is organized, check for the presence of a pulse.
o If ROSC, refer to Post Cardiac Arrest Management Guidelines.
o If asystole or PEA is present, resume CPR, and refer to the Asystole/PEA Guidelines.
o If the patient remains in a shockable rhythm, immediately resume CPR and refer to the
Ventricular Fibrillation/pulseless Ventricular Tachycardia Guidelines.
For All Defibrillation Attempts
• Perform chest compressions for 15-20 seconds while charging the defibrillator.
• Do not interrupt chest compressions for more than 5 seconds before or after shock delivery.
- For cardiac arrest in cases of suspected blunt or penetrating trauma and manage as follows:
1. SIGNS OF LIFE: If the patient has EMS-witnessed signs of life (movement, vocalization,
respiratory effort, swallowing, reactive pupils, reflexes, measurable vital signs), initiate
spinal immobilization and immediately transport to the closest Trauma Center
2. NO SIGNS OF LIFE: Use the Determination of Death Guidelines when there are no
signs of life AND the patient is asystolic
- Do not attempt placement of an advanced airway (supraglottic or endotracheal) for at least 6 minutes
(after three 2-minute cycles) unless necessary because of regurgitation.
a. Advanced airway insertion attempts MUST NOT interrupt chest compressions.
b. After securing the advanced airway, deliver ventilations without interrupting chest compressions:
1. Medical etiology cardiac arrest - 8 to 10 ventilations each minute
- Establish IV or IO access using normal saline as soon as feasible during the resuscitation attempt.
a. IV/IO access attempts MUST NOT interrupt chest compressions.
b. Flow rate:
1. TKO rate for medical cardiac arrests
2. Wide open rate for cardiac arrest caused by trauma. Upon ROSC, adjust rate to TKO
- If mechanism of injury AND symptoms AND physical exam suggest a tension pneumothorax
• Perform needle thoracostomy
• Contact BioTel
- Identify the presenting dysrhythmia and proceed to the appropriate dysrhythmia treatment guidelines.
- Summary of therapies by age:
|Definition by Age
||8th birthday and above
||1 year to 8th birthday
||Before 1st birthday
||30 compressions to 2
ventilations (pause foe
||15 compressions to 2
ventilations (pause for
||15 compressions to 2
ventilations (pause for
||1st choice: Manual
defibrillator with pediatric
defibrillator pads: 2 J/kg,
4 J/kg, 4-10 J/kg
2nd choice: AED with
pediatric AED pads
3rd choice: AED with
|Manual defibrillator with
pads: 2 J/kg, 4 J/kg, 4-10
Do not use an AED
||Standard adult dosing for
patients 14 and older;
weight-based dosing for
children 8 through 13