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ACLS Cardiac Arrest Algorithm (Asystole & PEA)

Updated: Oct 18, 2021

In today's video, we are focusing on the American Heart Association Cardiac arrests algorithm. We will specifically focus on the non-shockable rhythms, Asystole & Pulseless Electrical Activity (PEA)

What is the first thing we should do???🤔

⚠️ Focus: High-Quality CPR


Check responsiveness

-Activate emergency response system

-Check Carotid pulse/ Breathing for 5-

10 seconds

-Call for defibrillator ☎️


Assess for VF/ pulseless VT

If the monitor shows Asystole, confirm that it’s a true A-Systole.

Check Leads, Pads and that the monitor is setup correctly (Flat line protocol)

High-Quality CPR for 2 minutes ⏱

IV/ IO access

💉 Prepare and give Epinephrine 1 mg IV push q 3-5 min

The quicker we give Epinephrine in Asystole or PEA, the better the outcome.

Consider Advanced Airway

Don’t forget to use Waveform Capnography after Advanced Airway use.

With Advanced Airway in place during CPR, 1 breath every 6 seconds. (10 breaths/min)

Review after 2 minutes: ?VF/ pVT- Asystole

⚠️ Resume high-quality CPR without delay.

Never forget to consider your reversible causes.


  • Hypoxia

  • Hydrogen ion (Acidosis)

  • Hypothermia

  • Hyperkalemia/ Hypokalemia

  • Hypovolemia


  • Tension Pneumothorax

  • Thrombosis (Pulmonary)

  • Thrombosis (Coronary)

  • Tamponade (Cardiac)

  • Tablets

Remember: BLS is the foundation of our ACLS, if we don’t perform good BLS, the chances of us being successful in ACLS diminishes significantly.


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