Cardiac Arrest

Cardiac Arrest is a topic covered in the 5-Minute Emergency Consult.

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  • NOTE: The following information is based on 2010 Advanced Cardiac Life Support (ACLS) Guidelines. Any revisions made by the American Heart Association since then are not available at time of publication.
  • Major ACLS Changes for the 2010 revision include:
    • Change in the BLS sequence of treatment from A–B–C (airway, breathing, circulation) to C–A–B (circulation, airway, breathing) to emphasize early chest compressions
    • Emphasis on postcardiac arrest care, particularly implementation of targeted temperature management
    • Removal of atropine from PEA/asystole ACLS algorithms


  • Sudden cardiac arrest is characterized by:
    • Unresponsiveness
    • Pulselessness
    • Little to no respiratory effort
  • Factors affecting survival:
    • Initial rhythm
    • Total down time
    • Time to successful defibrillation (as indicated)
    • Time to basic life-support interventions


Contributing factors to cardiac arrest are outlined by the American Heart Association as:
  • Hypovolemia
  • Hypoxia
  • Hydrogen ion (acidosis)
  • Hypo-/hyperkalemia
  • Hypothermia
  • Toxins
  • Tamponade, cardiac
  • Tension pneumothorax
  • Thrombosis
  • Trauma

Pediatric Considerations
  • Sudden cardiac arrest in children is often of a respiratory rather than cardiac etiology
  • Follow current ACLS guidelines for pediatric cardiac arrest. Major differences between adult and pediatric cardiac arrest management include:
    • Depth of compressions for pediatric populations should be ∼1/3 to 1/2 the depth of the chest
    • For 2 rescuer CPR, a 15:2 compression to ventilation rate is recommended
    • Drug dosage differences: See “Medications” section

Pregnancy Considerations
Follow current ACLS guidelines for management of the pregnant cardiac arrest patient:
  • Awareness that airway may be difficult
  • Compressions should be performed at a higher location than conventional CPR, slightly above the center of the sternum
  • Follow Adult ACLS guidelines for defibrillation
  • Pre- or postcardiac arrest pregnant patients should be placed in the left lateral recumbent position; during arrest, perform manual left uterine displacement
  • To ensure a best possible outcome for the fetus, all efforts must be geared toward maternal survival
  • In the event of a failed maternal resuscitation, an emergent cesarean delivery may be considered

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