Adult Immediate Post–Cardiac Arrest Care Algorithm – 2015 Update

This figure conveys the Adult Immediate Post-Cardiac Arrest Care Algorithm, which was updated in 2015. It includes a flowchart on the left and a table of related information on the right. The flowchart consists of numbered boxes and hexagons linked together with arrows. It originates at the top with box number 1. This white box says, “Return of spontaneous circulation (ROSC).” An arrow points downward to box 2. This green box is titled, “Optimize ventilation and oxygenation.” It is followed by three points:
  • Maintain oxygen saturation greater than or equal to 94%.
  • Consider advanced airway and waveform capnography.
  • Do not hyperventilate.
An arrow points down from box 2 to box 3. This green box is titled, “Treat hypotension (SBP less than or equal to 90 millimeters of mercury.” It is followed by three points:
  • I.V. or I.O. bolus.
  • Vasopressor infusion.
  • Consider treatable causes.
An arrow points down to item 4, a red hexagon. It asks, “12-Lead ECG: Stemi or high suspicion of A.M.I.?” If the answer is “Yes,” an arrow points to the left to green box 5, which says, “Coronary reperfusion.” This box then points to item 6. If the answer is “No,” an arrow bypasses box 5 and points directly to item 6. Item 6 is a red hexagon that asks, “Follow commands?” If the answer is “No,” an arrow points to the left to box 7. This green box instructs, “Initiate targeted temperature management,” and then points to box 8. If the answer is “Yes,” the arrow bypasses box 7 and goes directly to box 8. This white box says, “Advanced critical care.” The one-column table to the right has two main sections. The first is “Doses or Details,” which contains five topics. It begins with “Ventilation or oxygenation.” Its instructions say, “Avoid excess ventilation. Start at 10 breaths per minute and titrate to target PETCO2 of 35 to 40 millimeters of mercury. When feasible, titrate FIO2 to minimum necessary to achieve SPO2 of greater than or equal to 94%. The next topic is “IV bolus.” It says, “Approximately 1 to 2 liters normal saline or lactated Ringer’s.” The third topic is “Epinephrine I.V. infusion.” It directs, “0.1 to 0.5 micrograms per kilogram per minute (in 70-kilogram adult: 7 to 35 micrograms per minute).” The fourth topic is “Dopamine IV infusion,” and it states, “5 to 10 micrograms per kilogram per minute.” The last topic in this section is “Norepinephrine IV infusion.” It says, “0.1 to 0.5 micrograms per kilogram per minute (in 70-kilogram adult: 7 to 35 micrograms per minute).” The second section of the table is titled “Reversible Causes.” It lists the following:
  • Hypovolemia.
  • Hypoxia.
  • Hydrogen ion (acidosis).
  • Hypo- or hyperkalemia.
  • Hypothermia.
  • Tension pneumothorax.
  • Tamponade, cardiac.
  • Toxins.
  • Thrombosis, pulmonary.
  • Thrombosis, coronary.
This figure is copyright 2015 by the American Heart Association.