Cardiac Arrest (ACLS) — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Is the rhythm shockable?
   Is the rhythm shockable (VF / pulseless VT vs asystole / PEA)? (High-quality CPR is central (compress ≥5 cm, 100–120/min, 30:2, minimize interruptions); pulse/rhythm check ≤10 s and every 2 min. Reversible causes (H's & T's): hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypothermia; tension pneumothorax, tamponade, toxins, thrombosis (PE/coronary).)
   • Shockable (VF / pulseless VT) → Shockable → defibrillate immediately
   • Non-shockable (asystole / PEA) → Non-shockable → CPR + epinephrine
2. [End] Shockable → defibrillate immediately
   Shockable rhythm (VF / pulseless VT): defibrillate immediately (biphasic 200 J; do not delay the shock to give drugs — epinephrine before defibrillation actually lowers survival) → CPR 2 min → after the 2nd shock give epinephrine 1 mg IV q3–5 min → after the 3rd shock give amiodarone 300 mg (then 150 mg) or lidocaine; recheck every 2 min and shock again if still shockable. Find and treat the H's & T's; on ROSC → post-arrest care (TTM / find the cause). Double-sequential defibrillation may be considered for refractory cases (not routine).
3. [End] Non-shockable → CPR + epinephrine
   Non-shockable rhythm (asystole / PEA): do not defibrillate; continuous high-quality CPR + early epinephrine 1 mg IV q3–5 min; place an advanced airway + waveform capnography. Focus on finding and correcting the reversible causes (the H's & T's — especially in PEA). Recheck the rhythm every 2 min — if it becomes shockable, treat as shockable. Pacing is ineffective once arrest has occurred. On ROSC → post-arrest care.

Source guidelines & references

• 2025 AHA Advanced Cardiovascular Life Support / cardiac arrest guidelines · source ↗

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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