The ACLS (Advanced Cardiovascular Life Support) cardiac arrest algorithm provides a step by step guideline for medical professionals. This guideline enables seamless intervention that helps effectively manage life threatening situations like pediatric cardiac or respiratory arrest.

This algorithm outlines the series of critical steps chronologically, to maximize the chances of positive patient outcomes. Emergencies are unpredictable and therefore it creates a lot of confusion and chaos, delaying emergency interventions.

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Step by step analysis of flowchart

  1. Confirm Cardiac Arrest
    • Understand via unresponsiveness, absence of normal breathing
  2. Check for Pulse 
    • Initiate CPR (Cardiopulmonary Resuscitation)
  3. Administer CPR
    • Rate: 100-200 Compressions per minute.
    • Ventilation 30:2 (If rescue breaths are provided)
  4. Monitor & use AED for shockable rhythms(ventricular fibrillation or pulseless ventricular tachycardia)(
    • Deliver single shock with CPR
  5. After using AED
    • Continue CPR for 2 minutes (5 cycles)
  6. Assess rhythm again after 2 mins of CPR
    • If shockable rhythm still persists: Deliver another shock and resume CPR immediately.
    • If rhythm is unshockable (asystole or pulseless electrical activity): Continue CPR
  7. Administer Epinephrine
    • 1 mg IV/IO every 3-5 minutes
  8. Continue
    • Alternate cycles of CPR
    • Rhythm assessment
    • Defibrillation (if needed)
    • Using Amiodarone or Lidocaine
  9. Optimize oxygenation and ventilation
    • Consider Endotracheal intubation or Supraglottic airway
  10. Treat reversible causes of Cardiac arrest
    • Hypoxia, Hypovolemia, Hydrogen ion [acidosis], Hypo-/Hyperkalemia, Hypothermia, and T’s: Tension pneumothorax, Tamponade, Toxins, Thrombosis—coronary and pulmonary).
  11. Continue Post-resuscitation care
    • Targeted temperature management
    • Optimize hemodynamics
    • Provide supportive care post-return of spontaneous circulation (ROSC)

Highlights of ACLS Cardiac Arrest Algorithm

  1. Recognition of Cardiac Arrest: Prompt identification of cardiac arrest through assessment of unresponsiveness, absence of normal breathing, and lack of pulse in the child.
  2. Activation of Emergency Response: Initiating the emergency response system and assigning roles to team members for efficient coordination.
  3. High-Quality CPR: Immediate initiation of high-quality chest compressions at a rate of 100 to 120 compressions per minute, ensuring adequate depth and allowing for full chest recoil between compressions. Coordinated ventilation with chest compressions at a ratio of 30:2 if providing rescue breaths.
  4. Defibrillation: Rapid attachment of a monitor/defibrillator to assess and deliver a shock if indicated for shockable rhythms such as ventricular fibrillation or pulseless ventricular tachycardia. 
  5. Medication Administration: Administration of medications such as epinephrine to support circulation and optimize outcomes. Other medications like amiodarone or lidocaine may be administered per ACLS guidelines based on the patient’s rhythm and condition.
  6. Systematic Rhythm Assessment: Regular assessment of the patient’s cardiac rhythm to determine the need for defibrillation and to guide further interventions.
  7. Management of Reversible Causes: Identification and treatment of underlying reversible causes of cardiac arrest, such as hypoxia, hypovolemia, electrolyte imbalances, toxins, tension pneumothorax, tamponade, and thrombosis.
  8. Advanced Airway Management: Consideration and implementation of advanced airway management techniques, including endotracheal intubation or supraglottic airway placement, to optimize oxygenation and ventilation if indicated.
  9. Post-Resuscitation Care: Initiation of targeted temperature management (if indicated), optimization of hemodynamics, and provision of supportive care following return of spontaneous circulation (ROSC).
  10. Transport: Arrangement for immediate transfer to an appropriate care facility for further evaluation and management post-ROSC.

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