VF/VT rhythms in ALS

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Shockable rhythms (VF/VT)

Sequence of actions are summarised (1):

  • (1) confirm cardiac arrest – check for signs of life or if trained to do so, breathing and pulse simultaneously.
  • (2) call resuscitation team.
  • (3) perform uninterrupted chest compressions while applying self-adhesive defibrillation/monitoring pads – one below the right clavicle and the other in the V6 position in the midaxillary line.
  • (4) plan actions before pausing CPR for rhythm analysis and communicate these to the team.
  • (5) stop chest compressions; confirm VF from the ECG.
  • (6) resume chest compressions immediately; simultaneously, the designated person selects the appropriate energy on the defibrillator (150-200 J biphasic for the first shock and 150-360 J biphasic for subsequent shocks) and presses the charge button.
  • (7) while the defibrillator is charging, warn all rescuers other than the individual performing the chest compressions to “stand clear” and remove any oxygen delivery device as appropriate. Ensure that the rescuer giving the compressions is the only person touching the patient.
  • (8) once the defibrillator is charged, tell the rescuer doing the chest  compressions to ”stand clear”; when clear, give the shock.
  • (9) without reassessing the rhythm or feeling for a pulse, restart CPR using a ratio of 30:2, starting with chest compressions.
  • (10) continue CPR for 2 min; the team leader prepares the team for the next pause in CPR.
  • (11) pause briefly to check the monitor.
  • (12) if VF/VT, repeat steps 6 - 11 above and deliver a second shock.
  • (13) if VF/VT persists repeat steps 6 - 8 above and deliver a third shock. Resume chest compressions immediately and then give adrenaline 1 mg IV and amiodarone 300 mg IV while performing a further 2 min CPR.
  • (14) repeat this 2 min CPR – rhythm/pulse check – defibrillation sequence if VF/VT persists.
  • (15) give further adrenaline 1 mg IV after alternate shocks (i.e., approximately every 3-5 min).

If organised electrical activity is seen during this brief pause in compressions, check for a pulse (Central Pulse and End-tidal CO2)

  • if a pulse is present, start post-resuscitation care
  • if no pulse is present, continue CPR and switch to the nonshockable algorithm

If asystole is seen, continue CPR and switch to the nonshockable algorithm.


Last reviewed 01/2018