Indications
- • Unresponsive + not breathing normally + no pulse (or uncertain)
Contraindications
- ⚠ Valid DNACPR / advance decision
- ⚠ Obvious irreversible death (rigor, decapitation, hypostasis)
Equipment
- • BLS: hands, bag-valve-mask, AED
- • ALS: defibrillator, airway adjuncts, drugs trolley, ETT kit
Technique
- • Danger → Response → Shout for help → Airway → Breathing → Circulation
- • Call resuscitation team (use your local code / number)
- • Start chest compressions: 30:2, depth 5–6 cm, rate 100–120/min, allow full recoil
- • Attach defibrillator/AED as soon as available — analyse rhythm
- • Shockable (VF/pVT): shock 150–200 J biphasic → 2 min CPR → adrenaline 1 mg after 3rd shock + amiodarone 300 mg → continue cycles
- • Non-shockable (PEA/asystole): adrenaline 1 mg IV ASAP then every 3–5 min → 2 min CPR cycles
- • Address reversible causes — 4 Hs + 4 Ts (hypoxia, hypovolaemia, hypo/hyperkalaemia + metabolic, hypothermia; thrombosis, tamponade, tension PTX, toxins)
- • Consider advanced airway (ETT / SGA) and capnography
Complications
- ⚠ Rib/sternum fractures
- ⚠ Pneumothorax, pulmonary contusion
- ⚠ Liver/splenic laceration
- ⚠ Aspiration
Aftercare
- • Post-ROSC: A–E, 12-lead ECG, ABG, targeted temperature management, ITU transfer
- • Debrief team
- • Inform family + document fully
Clinical pearls
- • High-quality compressions save lives — minimise interruptions to <10 s
- • Switch compressor every 2 min
- • Capnography <10 mmHg after 20 min predicts poor outcome
Perform under supervision until competent. Follow local SOPs and consent policy.
