Asystole or PEA



Initiate or maintain CPR

►IV/IO vascular access without interruption of CPR

For PEA administer Fluid Bolus before other treatments

250 mL NS bolus, may repeat to max of 1 liter to attain and maintain perfusion

Epinephrine 1 mg IV / IO (0.1 mg/mL) approximately every 3 minutes

→ Correct possible reversible causes:
Hypovolemia, acidosis, hypoxia, tension pneumothorax, hypothermia, toxins

D10 25 gm/250 mL (50% solution) IVPB / IO

If diabetic and hypoglycemia suspected: (No D-stick, Non-Traumatic FA)

Epinephrine can be given with D10, there is no negative reaction

Advanced Airway with minimal interruption of CPR after 4-6 min of CPR

If prior to transport the pt develops a rhythm with pulse:
Make BHC and transport to available Cardiovascular Receiving Center (CVRC)

For continued PEA or asystole:

→ Maintain CPR and transport to nearest PRC or make Base contact to: Provide further resuscitation orders
Request pronouncement of patient in the field


→Interruption of chest compressions should always be held to a minimum


→Agonal gasps are not adequate breathing and when accompanied with a pulseless state, the patient should be considered to be in full cardiopulmonary arrest


→If Base Hospital orders Push-Dose Epinephrine for refractory hypotension, refer to Push-Dose Epinephrine procedure


1:10,000 = 0.1mg/mL

1:1000 = 1mg/mL