Cardiac Arrest - Non-shockable (Asystole/PEA)

🔑 Key Priorities

  • Declare emergency: "This is a CRISIS – Non-Shockable Arrest (Asystole or PEA)"

  • High-quality uninterrupted CPR

  • Immediate identification and correction of reversible causes

🧠 Team Actions

Role

Task

Team Leader

Coordinate, manage rhythm checks and CPR timing

Airway Manager

Secure airway, 100% O2, monitor EtCO₂

Circulation Lead

IV/IO access, administer drugs

Compressor

CPR (100–120/min), rotate every 2 mins

Recorder

Document timings, drugs, ECG rhythm

🧭 Management Algorithm

Start Immediately:

  1. Begin CPR (100–120/min), 100% O₂

  2. Confirm rhythm is non-shockable (Asystole/PEA)

  3. Administer Adrenaline 1mg IV as soon as possible

  4. Resume CPR for 2-minute cycles

Ongoing Cycles:

  • Repeat adrenaline every 2nd cycle

  • Perform rhythm check and pulse check every 2 minutes

  • Actively search for and correct reversible causes

Additional Considerations:

  • Use EtCO₂ monitoring to confirm CPR quality (target EtCO₂ >10–20 mmHg)

  • Consider ultrasound to assess cardiac activity and rule out tamponade or thrombus

  • Avoid fluid overload unless hypovolaemia suspected

  • Prepare for ROSC or transition to end-of-resuscitation care

💉 Drug Table (Adult)

Drug

Dose

Indication

Adrenaline

1mg IV every 3–5 min

Core resuscitation drug

Calcium Chloride

10mL of 10%

Hyperkalaemia, hypocalcaemia

Sodium Bicarbonate

1–2mL/kg of 8.4%

Hyperkalaemia, TCA overdose

💉 Drug Table (Paediatric)

Drug

Dose

Notes

Adrenaline

10mcg/kg IV or IO

Every 3–5 mins

Calcium Chloride

0.1–0.2mL/kg of 10%

Hyperkalaemia

Sodium Bicarbonate

1mEq/kg of 8.4%

TCA/antidepressant overdose

🔁 Reversible Causes: 4 Hs & 4 Ts

(Same as VF/VT)

  • Hypoxia

  • Hypovolaemia

  • Hypo/Hyperkalaemia

  • Hypothermia

  • Tension pneumothorax

  • Tamponade (cardiac)

  • Toxins

  • Thrombosis (cardiac or pulmonary)

🔄 Ideal Crisis Flow

       Asystole / PEA Arrest
               ↓
        High-Quality CPR
               ↓
    → Adrenaline ASAP (then every 4 mins)
    → Secure Airway + 100% O2
    → Rhythm Check Every 2 min
    → Check for Reversible Causes
    → Consider POCUS for diagnosis
    → Reassess CPR quality via EtCO₂

🧊 Post-ROSC Care

  • Support circulation (MAP >65 mmHg)

  • Manage airway and ventilation (SpO₂ 94–98%)

  • Avoid hyperglycaemia, hypercarbia, hyperoxia

  • Consider targeted temperature management

  • Arrange ICU referral and documentation

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