Immediate management

Start basic life support:  ^a

Check responsiveness	shake and shout
Open airway	head tilt/chin lift
Check breathing	look, listen, feel
Breathe	2 effective breaths
Assess for 10 seconds	signs of circulation

Send or go for help as soon as possible. ^a

If possible, perform interposed abdominal counterpulsation (compression over the umbilicus to co-ordinate with early relaxation of chest compression (rate 80 to 100 per minute) ^a  

Advanced Life Support Protocol

BLS algorithm if appropriate

Perform a precordial thump a if appropriate

Attach defibrillator/monitor

Assess rhythm

Check pulse

VT/VF	non-VT/VF
Attempt defibrillation a b  x 3 d as necessary; 200 J, 200 J, 360 J on first cycle d;  360 J thereafter d	CPR for up to 3 minutes d
CPR for 1 minutes, then repeat if necessary
Give either adrenaline 1mg d every 3 to 5 minutes d or vasopressin d 40 units iv single dose once only	Give adrenaline d 1mg d every 3 to 5 minutes d

During CPR

• Check electrode/paddle positions and contacts ^a

• Attempt to place, confirm, secure airway ^a and oxygen. ^a

  • Insert a laryngeal mask if unfamiliar with endotracheal tubes. ^b  
• Attempt and verify early IV access
• Search for and correct reversible causes. ^d

There is no clear benefit from

• active compression-decompression cardiopulmonary resuscitation ^a 
• adrenaline ^{a  b}  
• amiodarone ^a  
• vasopressin ^d  
• atropine for brady-asystolic arrest ^b  
• external pacing for asystole or pulseless electrical activity ^d  
• calcium chloride ^b  
• buffer therapy  ^d  
• magnesium  ^d   
• bretylium sulphate   ^b  
• lignocaine  ^b  
• pneumatic trousers  ^d  
• calcium antagonists (e.g. lidoflazine ^d  or nimodipine)  ^d  

• arrest not witnessed or monitored
• initial rhythm not VT or VF
• no pulse regained within first 10 minutes

If resuscitation is successful, perform investigations.

If your patient remains in a coma, consider therapeutic hypothermia for 24 hours. ^a