AHA 2010 ACLS Algorithm

American Heart Association 2010 ACLS Algorithm.

CPR Quality

• Push hard (≥2 inches [5 cm]) and fast (≥100/min) and allow complete chest recoil
• Minimize interruptions in compressions
• Avoid excessive ventilation
• Rotate compressor every 2 minutes
• If no advanced airway, 30:2 compression-ventilation ratio
• Quantitative waveform capnography
• If Petco2 <10 mm Hg, attempt to improve CPR quality
• Intra-arterial pressure
• If relaxation phase (diastolic) pressure <20 mm Hg, attempt to improve CPR quality

Return of Spontaneous Circulation (ROSC)

• Pulse and blood pressure
• Abrupt sustained increase in Petco2 (typically ≥40 mm Hg)
• Spontaneous arterial pressure waves with intra-arterial monitoring

Shock Energy

• Biphasic: Manufacturer recommendation (120-200 J); if unknown, use maximum available. Second and subsequent doses should be equivalent, and higher doses may be considered.
• Monophasic: 360 J

Drug Therapy

• Epinephrine IV/IO Dose: 1 mg every 3-5 minutes
• Vasopressin IV/IO Dose: 40 units can replace first or second dose of epinephrine
• Amiodarone IV/IO Dose: First dose: 300 mg bolus. Second dose: 150 mg.

Advanced Airway

• Supraglottic advanced airway or endotracheal intubation
• Waveform capnography to confirm and monitor ET tube placement
• 8-10 breaths per minute with continuous chest compressions

Reversible Causes

• Hypovolemia
• Hypoxia
• Hydrogen ion (acidosis)
• Hypo-/hyperkalemia
• Hypothermia
• Tension pneumothorax
• Tamponade, cardiac
• Toxins
• Thrombosis, pulmonary
• Thrombosis, coronary