How should you manage a non-shockable rhythm (asystole or PEA) in cardiac arrest?

How should you manage a non-shockable rhythm (asystole or PEA) in cardiac arrest?

• A. High-quality CPR, identify and treat reversible causes (Hs and Ts), and give epinephrine 1 mg IV/IO every 3-5 minutes
• B. Deliver shock immediately
• C. Start CPR but do not give epinephrine
• D. Wait for ROSC

Answer: (A)

In non-shockable cardiac arrest rhythms, the priority is to restore and maintain perfusion while addressing treatable underlying problems. High-quality CPR with minimal interruptions keeps blood flowing to the brain and heart, while actively identifying and treating reversible causes (the Hs and Ts) such as hypoxia, hypovolemia, electrolyte disturbances, acidosis, toxins, tamponade, tension pneumothorax, and thrombosis. Epinephrine 1 mg IV/IO every 3-5 minutes is given to improve perfusion pressures during CPR and increase the chance of ROSC. Defibrillation isn’t effective for asystole or pulseless electrical activity, so delivering a shock would not help and delays ongoing CPR and cause treatment gaps. Waiting for ROSC without continuing CPR and addressing reversible causes also reduces survival chances.

In non-shockable cardiac arrest rhythms, the priority is to restore and maintain perfusion while addressing treatable underlying problems. High-quality CPR with minimal interruptions keeps blood flowing to the brain and heart, while actively identifying and treating reversible causes (the Hs and Ts) such as hypoxia, hypovolemia, electrolyte disturbances, acidosis, toxins, tamponade, tension pneumothorax, and thrombosis. Epinephrine 1 mg IV/IO every 3-5 minutes is given to improve perfusion pressures during CPR and increase the chance of ROSC. Defibrillation isn’t effective for asystole or pulseless electrical activity, so delivering a shock would not help and delays ongoing CPR and cause treatment gaps. Waiting for ROSC without continuing CPR and addressing reversible causes also reduces survival chances.