⚡ Adult VF/Pulseless VT (ACLS)
This tool summarizes ACLS management of adult shockable rhythms (VF/pulseless VT): defibrillation energy, epinephrine timing, and antiarrhythmic dosing, per AHA 2020/2025.
Defibrillate as a single shock then immediately resume CPR without stacking shocks; give epinephrine after the second shock in shockable rhythms. (original synthesis · not guideline verbatim)
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
When to use
Use during resuscitation to anchor the sequence — immediate single defibrillation with high-quality CPR, epinephrine every 3–5 minutes, antiarrhythmics for refractory arrest, magnesium for torsades, and structured post-ROSC care.
How it works
Branches: shock (biphasic 120–200 J + CPR + epinephrine 1 mg q3–5min) → refractory (amiodarone 300→150 mg or lidocaine 1–1.5 mg/kg, treat 5H5T) → torsades (magnesium 1–2 g) → ROSC (post-arrest care, TTM, reversible causes).
Key points
- Defibrillate as a single shock then immediately resume CPR without stacking shocks; give epinephrine after the second shock in shockable rhythms. (original synthesis · not guideline verbatim)
- Amiodarone and lidocaine are equivalent options for refractory VF/pVT — choose one, do not combine.
- Torsades/polymorphic VT with long QT is treated with magnesium sulfate plus correction of K/Mg and removal of QT-prolonging drugs.
References
- Panchal AR, et al. Part 3: Adult Basic and Advanced Life Support. AHA Guidelines for CPR and ECC. Circulation 2020.
- American Heart Association — 2025 ACLS Cardiac Arrest Algorithm.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Current situation | VF/pulseless VT (during resuscitation) |
|---|
→VF/pulseless VTShock + CPR + epinephrine
- Immediate defibrillation：Single shock: biphasic 120–200 J (per manufacturer; if unknown use maximum) first, then equal or escalating; monophasic 360 J. Resume high-quality CPR immediately after the shock (do not stack shocks)
- CPR：Compressions 100–120/min, depth 5–6 cm, full recoil, minimize interruptions; recheck rhythm after each 2-minute cycle
- Epinephrine：1 mg IV/IO every 3–5 minutes (give after the 2nd shock in a shockable rhythm)
| Current situation | ROSC achieved (return of spontaneous circulation) |
|---|
→VF/pulseless VTPost-arrest care
- Post-conversion care：Enter post-arrest care: maintain oxygenation/ventilation (avoid hyper/hypoxia, hyper/hypocapnia), maintain MAP/perfusion, 12-lead ECG, emergent coronary evaluation
- Temperature management：Comatose patients: implement temperature control 32–37.5°C (see the 'Post-arrest TTM' tool)
- Antiarrhythmic：Maintenance antiarrhythmic may be considered; identify and correct reversible causes (ischemia, electrolytes)
Frequently asked questions
- What is Adult VF/Pulseless VT (ACLS)?
- This tool summarizes ACLS management of adult shockable rhythms (VF/pulseless VT): defibrillation energy, epinephrine timing, and antiarrhythmic dosing, per AHA 2020/2025.
- How is Adult VF/Pulseless VT (ACLS) calculated? What is the core formula?
- Branches: shock (biphasic 120–200 J + CPR + epinephrine 1 mg q3–5min) → refractory (amiodarone 300→150 mg or lidocaine 1–1.5 mg/kg, treat 5H5T) → torsades (magnesium 1–2 g) → ROSC (post-arrest care, TTM, reversible causes).
- When is Adult VF/Pulseless VT (ACLS) used?
- Use during resuscitation to anchor the sequence — immediate single defibrillation with high-quality CPR, epinephrine every 3–5 minutes, antiarrhythmics for refractory arrest, magnesium for torsades, and structured post-ROSC care.
- What are the key clinical points for Adult VF/Pulseless VT (ACLS)?
- Defibrillate as a single shock then immediately resume CPR without stacking shocks; give epinephrine after the second shock in shockable rhythms. (original synthesis · not guideline verbatim) Amiodarone and lidocaine are equivalent options for refractory VF/pVT — choose one, do not combine. Torsades/polymorphic VT with long QT is treated with magnesium sulfate plus correction of K/Mg and removal of QT-prolonging drugs.
- What are the limits and cautions when using Adult VF/Pulseless VT (ACLS)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Adult VF/Pulseless VT (ACLS) calculated in practice? Can you show a worked example?
- Inputs: Current situation VF/pulseless VT (during resuscitation) → Result: VF/pulseless VT Shock + CPR + epinephrine（Immediate defibrillation: Single shock: biphasic 120–200 J (per manufacturer; if unknown use maximum) first, then equal or escalating; monophasic 360 J. Resume high-quality CPR immediately after the shock (do not stack shocks), CPR: Compressions 100–120/min, depth 5–6 cm, full recoil, minimize interruptions; recheck rhythm after each 2-minute cycle, Epinephrine: 1 mg IV/IO every 3–5 minutes (give after the 2nd shock in a shockable rhythm)） Inputs: Current situation ROSC achieved (return of spontaneous circulation) → Result: VF/pulseless VT Post-arrest care（Post-conversion care: Enter post-arrest care: maintain oxygenation/ventilation (avoid hyper/hypoxia, hyper/hypocapnia), maintain MAP/perfusion, 12-lead ECG, emergent coronary evaluation, Temperature management: Comatose patients: implement temperature control 32–37.5°C (see the 'Post-arrest TTM' tool), Antiarrhythmic: Maintenance antiarrhythmic may be considered; identify and correct reversible causes (ischemia, electrolytes)）