Critical Care Emergencies 7CARDIOPULMONARY RESUSCITATIONMANAGEMENT
1 Ventricular fibrillation or pulseless ventricular tachycardia
VF is asynchronous, chaotic ventricular depolarization and repolarization
producing no cardiac output. Pulseless VT is a wide-complex, regular tachy-
cardia associated with no clinically detectable cardiac output.
(i) Give a DC shock once VF/VT is confirmed on the monitor:
(a) deliver 150–200 J using a biphasic defibrillator
(b) deliver 360 J if using an older monophasic defibrillator
(c) deliver this shock with less than 5 s delay to cardiac
compressions.
(ii) Immediately resume CPR, continuing with chest compressions
to ventilations at a ratio of 30:2, if the airway has not yet been
secured
(a) do not delay CPR by reassessing the rhythm or feeling for a pulse
(b) perform compressions at 100/min and ventilations at 10/min
without interruption if the airway has been secured by now.
(iii) Continue CPR for 2 min, then briefly pause to reassess the
rhythm on the monitor
(a) if there is still VF/VT, give a second DC shock of 150–360 J
biphasic or 360 J monophasic
(b) immediately resume CPR after this shock.
(iv) Briefly pause after another 2 min of CPR to check the monitor:
(a) give by a third shock of 150–360 J biphasic or 360 J
monophasic and resume CPR.
(v) Continue compressions and give:
(a) 10 mL of 1 in 10 000 adrenaline (epinephrine) (1 mg) i.v.
(b) a bolus of amiodarone 300 mg i.v. diluted in 5% dextrose to a
volume of 20 mL if VF/VT persist.
2 Irrespective of the arrest rhythm, give additional 1 in 10 000 adrenaline
(epinephrine) 1 mg (10 mL) every 3–5 min until return of spontaneous circu-
lation (ROSC).
(i) This will be once every two cycles of the algorithm (see Fig. 1.1).
(ii) Meanwhile continue providing CPR and make sure to change the
person performing cardiac compressions every 2 min, to preserve
optimum efficacy.
3 Continue the drug–shock–CPR–rhythm check sequence.
(i) Analyse the rhythm again after another 2 min of CPR:
(a) immediately deliver a fourth shock if still in VF/VT.
4 Look for signs of life suggesting ROSC, or palpate for a pulse once a
non-shockable rhythm is present with regular or narrow complexes.
(i) Resume CPR if the pulse is absent or difficult to feel.
(ii) Begin post-resuscitation care when a strong pulse is felt, or the
patient shows signs of life suggesting ROSC. See page 11.