Version control: This document is current with respect to 2015 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 for an updated document.

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Using the Pulseless Arrest Algorithm for Managing VF and Pulseless VT

The ACLS Pulseless Arrest Algorithm is the most important algorithm to know when resuscitating adults. The algorithm steps through the assessment and management of a patient with no pulse who does not respond to the interventions of the primary survey, including an initial shock from an automated external defibrillator (AED). Pulseless VT is included in the algorithm with VF. For treatment purposes, pulseless VT is treated the same as ventricular fibrillation

The Pulseless Arrest Algorithm picks up after the primary survey has already been conducted:


Maintain CPR. Interrupt chest compressions only for ventilation, rhythm checks, and actual shock delivery. CPR should never be interrupted for more than 10 seconds. Remind team members that they can prepare the drugs used ahead of time and minimize patient's time without CPR.

  1. Begin 5 cycles of CPR (approximately 2 minutes) immediately after the first shock. Each cycle contains 30 chest compressions followed by 2 breaths.
  2. Attach the patient to the monitor/defibrillator and analyze the patient’s rhythm.
  3. Check the patient's rhythm in less than 10 seconds.




If non-shockable rhythm is present

AND QRS complexes appear regular and narrow

Check for a pulse

If non-shockable rhythm is present

WITH no pulse

Follow treatment for PEA or asystole

If a shockable rhythm is present

WITHOUT a pulse

Continue CPR while defibrillator is charging

  1. Continue CPR until the defibrillator has been charged.
    • Turn oxygen away from the patient's chest OR turn it off.
    • Make sure the source of oxygen is removed from the patient when you clear to shock.
    • Check to see that no caregivers are touching the patient.
    • Shock. If using biphasic, use manufacturer recommended dosage. Press the shock button.
  2. Immediately resume CPR for 5 cycles.
  3. If IV/IO is available, administer epinephrine 1mg IV/IO during the CPR cycle (see drug administration in PDF file on right).
  4. Check rhythm in less than 10 seconds.
  5. If a shockable rhythm is present, give 1 shock.
    • Continue CPR while the defibrillator is charging.
    • Clear the patient for shock .
    • Deliver the shock.
    • Resume CPR immediately after shock, 5 cycles.

Following the sequence in the algorithm is the best scientific approach to restore spontaneous circulation.