ACLS 2015 Algorithm for Cardiac Arrest

Authors: Michelle Lin, MD, Jeremy Voros, MD
Updated: 12/16/2011

ACLS 2015 Algorithm for Cardiac Arrest

2015 ACLS cardiac arrest algorithm


  • 2 minutes of continuous, uninterrupted CPR is key before rechecking the rhythm.
  • Think about giving epinephrine every OTHER time you check the rhythm. This puts it at roughly a q4 minute dosing (recommended q3-5 minutes).
  • Don't delay CPR when you recognize a cardiac arrest. That means do this first, and then work on giving oxygen, placing the patient on various monitors, setting up the defibrillator, and establishing IV/IO access. Hence, the C-A-B mnemonic (Circulation before Airway)
  • Chest compressions should be "hard and fast" -- Depth of at least 2 inches and ≥ 100 compressions with a target PCO2 on the end-tidal capnography of ≥10 mm Hg.
  • Use your mobile phone's timer to help alert you every time when 2 minutes is up.

Additional reversible causes

(not listed on ACLS AHA guidelines)

  • Hypoglycemia
  • Trauma

Return of Spontaneous Circulation

  • Pulse and blood pressure
  • PETCO2 abruptly sustained increase (typically ≥ 40 mm Hg)

Post-Cardiac Arrest Care

Ventillation & Oxygenation:

  • Start at 10 breaths per minute
  • Titrate to target PCO2 30-40 mm Hg
  • Titrate FIO2 to minimum necessary to achieve SpO2 ≥ 94%

Treat Hypotension

  • IV/IO bolus: 1-2L normal saline or lactate
  • Vasopressor infusion as needed:
    • Epinepherine IV 0.1-0.5 mcg/kg per minute
    • Dopamine IV 5-10 mcg/kg per minute
    • Norepihephrine IV 0.1-0.5 mcg/kg per minute

Evaluate Need for Coronary Catheterization

  • 12-Lead ECG STEMI or high suspicion of acute myocardial infarction? Proceed to coronary reperfusion.

Targeted Temperature Management

  • If no meaningful response to verbal stimuli, maintain a constant temperature between 32°C and 36°C

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  • Neumar RW, Shuster M, Callaway CW, et al. Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S315-67. [PubMed]