Version control: This document is current with respect to the latest 2016 American Heart Association® Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020. If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document.

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The cornerstone of a successful resuscitation is delivering quality compressions for the highest percentage of time possible during the resuscitation (at least 60%). Throughout the following algorithm, compressions are continuous except where noted otherwise, such as during defibrillation.

  1. Identify cardiac arrest
  2. Begin CPR
    1. Compressions 30:2 (single rescuer) 15:2 (2 rescuers)
    2. Rate – at least 100 but less than 120/min
    3. Depth - > 1/3 of the depth of the anterior/posterior chest
    4. Rotate compressors every 2 minutes throughout the resuscitation
    5. Ventilation with supplemental oxygen – utilize waveform capnography if available
  3. Shockable rhythm
    1. Defibrillate starting at 2 joules/kg
    2. Immediately following each defibrillation, compressions are continued for 2 minutes
    3. Obtain IV/IO Access
    4. Defibrillate at 4 joules/kg
    5. CPR 2 minutes
    6. Epinephrine 0.01mg/kg (0.1ml/kg of 1:10,000) every 3–5 minutes during the length of the resuscitation
    7. Defibrillate at greater than 4 joules/kg (maximum 10 joules/kg)
    8. CPR 2 minutes
    9. Amiodarone 5mg/kg (can be repeated twice) or lidocaine 1mg/kg
  4. Nonshockable Rhythm
    1. Begin CPR immediately
    2. Obtain IV/IO access
    3. Epinephrine 0.01mg/kg (0.1ml/kg of 1:10,000) every 3–5 minutes throughout the resuscitation
  5. Search for and treat reversible causes
    1. Hypovolemia
    2. Hypoxia
    3. Hydrogen ion(acidosis)
    4. Hypo/Hyperkalemia
    5. Hypothermia
    6. Tension pneumothorax
    7. Tamponade, cardiac
    8. Toxins
    9. Thrombosis, pulmonary
    10. Thrombosis, coronary