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

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🧠 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

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🧭 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

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💉 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

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💉 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

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🔁 Reversible Causes: 4 Hs & 4 Ts

(Same as VF/VT)

• Hypoxia

• Hypovolaemia

• Hypo/Hyperkalaemia

• Hypothermia

• Tension pneumothorax

• Tamponade (cardiac)

• Toxins

• Thrombosis (cardiac or pulmonary)

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🔄 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

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🧊 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