ADULT

Asystole or PEA

Algorithm

New UPDATED 10/1/2021

Pit Crew CPR

Initiate an organized approach to CPR with responders in designated positions

 

 

 

 

PEA / Asystole:

CPR --- 0 minutes

Continue High Quality CPR without interruption unless pulse obtained

Witnessed Arrest - Consider passive ventilation for 6 min.

Un-witnessed Arrest - BVM / ETCO2 or Supraglottic airway unless:

ET indicated (Laryngeal edema from smoke inhalation)

Continue compression for approx. 2 min., then reassess

Place patient at 30 degrees - Semi-fowler if possible (ACCD)

Apply Automatic Chest Compression device when available before movement

 

►IV/IO vascular access without interruption of CPR

PEA / Asystole:

CPR --- 2 minute Reevaluate

Continue High Quality CPR without interruption unless pulse obtained

PEA / Asystole:

DRUG --- 3 minute Epi #1

Maintain CPR 2 min

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

PEA / Asystole:

Fluid Bolus --- 3 minute Fluid Bolus

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

→ Correct possible reversible causes:

Hypovolemia, acidosis, hypoxia, tension pneumothorax, hypothermia, toxins

PEA / Asystole:

CPR --- 4 minute Reevaluate

Evaluate the Patient for shockable rhythms

Continue High Quality CPR without interruption unless pulse obtained

PEA / Asystole:

CPR --- 6 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

DRUG --- 7 minute Epi #2

Maintain CPR 2 min

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

PEA / Asystole:

CPR --- 8 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

CPR --- 10 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole: 

INTUBATION --- 11 minute Intubation / Bicarb

Intubate with minimal interruption of CPR after 10 min of CPR

Sodium Bicarbonate 50 mL IV / IO

Maintain CPR

PEA / Asystole:

DRUG --- 12 minute Epi #3

Maintain CPR 2 min

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

PEA / Asystole:

CPR --- 12 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

CPR --- 14 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

CPR --- 16 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

DRUG --- 17 minute Epi #4

Maintain CPR 2 min

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

PEA / Asystole:

CPR --- 18 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

CPR --- 20 minute Reevaluate

Evaluate the Patient for shockable rhythms

Decision Point

1) Remain on scene and continue with treatment (After 30 minutes, choose option 2 or 3)

2) Initiate transport to nearest ERC

3) Base Contact for further orders or pronouncement of patient in the field

RETURN OF SPONTANEOUS CIRCULATION (ROSC)

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

 → Assess for and correct suspected:

Hypoxia, Hypovolemia, Hypoglycemia, and Hypothermia

D10 25 gm/250 mL (10% 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

 

Interruption of chest compressions should always be held to a minimum.
Pads can be placed in the antero-lateral and antero-posterior positions;
For implanted pacemaker/defibrillator place pads to either side and not directly on top of the implanted device. For medication patch: remove patch, wipe area clean before attaching an electrode pad.

1:10,000 = 0.1mg/mL

1:1000 = 1mg/mL