Epinephrine change
The administration of Epinephrine 1 mg every 3 to 5 minutes has been the standard medication within the cardiac arrest algorithm. An option to provide epinephrine every four minutes as a midrange has been added. This allows the provider to administer epinephrine every other two-minute rhythm check.
Amiodarone and lidocaine change
Amiodarone and lidocaine are now considered equivalent in the treatment of ventricular fibrillation or pulseless ventricular tachycardia. Either amiodarone or lidocaine may be used.
Waveform capnography
Quantitative waveform capnography with a bag-mask device to confirm and monitor CPR quality is now recommended. Prior to the 2020 guidelines, the recommendation for quantitative waveform capnography monitoring was limited to monitoring only after endotracheal tube placement.
Wahaj Fatmi says
Hi, with regards to shock able rhythm and timing of first dose of epinephrine, is it necessary to give first dose of epinephrine after 2 cycles of shock or we should give epinephrine as soon as IV access is obtained.
Secondly should the drugs i.e. epinephrine and amiodarone be given during active compression so as to improve the drug delivery or during the pulse check interval.
Regards
ACLS says
American heart association puts Epinephrine after the second shock during CPR. This ensures that there will be no delay in chest compressions and ventilations. It is up to the physician’s discretion whether to follow the algorithm strictly or to give the epi after the first shock during CPR. Some do this.
Medication’s should always be given just after the shock during CPR. This helps ensure adequate drug delivery.
Kind regards,
Jeff
kadry says
if we start the algorithm with non shockable rhythm , and started to give epinephrine every 4 minutes , and rhythm changed to shockable rhythm , should we stopped epinephrine and start again after 2nd shock , or to continue epinephrine every 4 minutes as epinephrine once started never stopped ??
Thank you in advance
ACLS says
Once you have started giving Epinephrine continue every four minutes as long as cardiac arrest continues.
Kind regards,
Jeff
Dr Kaukab Nadeem says
Excellent informative recent gauidlines
Rob Lee says
Thank you for your guys’ dedication to this material!
– Former Army medic soon to be RN BSN
Laura Cox says
Hi! Did the joules for monophasic defibrillation change? Wasn’t it 200, 300, 360? And is it now just 360J from the start? Thanks.
ACLS says
For some time the monophasic dosing calls for 1st dose to be 360 J and all subsequent doses to be 360 J. I think this was a 2010 change.
Kind regards,
Jeff
Margaret Henry says
Thank you