Pulseless Arrest Algorithm for Managing

VF and Pulseless VT

Using the Pulseless Arrest Algorithm for Managing

VF and Pulseless VT
The ACLS Pulseless Arrest Algorithm is the most important algorithm to know when
resuscitating adults. The algorithm steps through the assessment and management of a
patient with no pulse who does not respond to the interventions of the primary survey,
including an initial shock from an automated external defibrillator (AED). Pulseless VT is
included in the algorithm with VF. For treatment purposes, pulseless VT is treated the
same as ventricular fibrillation

The Pulseless Arrest Algorithm picks up after the

primary survey has already been conducted:
The emergency response system has been activated

CPR is being performed

An AED has been attached

The first shock has been given

Steps
Maintain CPR. Interrupt chest compressions only for ventilation, rhythm checks, and
actual shock delivery. CPR should never be interrupted for more than 10 seconds.
Remind team members that they can prepare the drugs used ahead of time and
minimize patient's time without CPR.

1. Begin 5 cycles of CPR (approximately 2 minutes) immediately after the first

shock. Each cycle contains 30 chest compressions followed by 2 breaths.
 2. Attach the patient to the monitor/defibrillator and analyze the patients rhythm.

3. Check the patient's rhythm in less than 10 seconds.

Rhythm Condition Action

If non-shockable AND QRS complexes appear Check for a pulse

rhythm is present regular and narrow

If non-shockable WITH no pulse Follow treatment for PEA or

rhythm is present asystole

If a shockable rhythm WITHOUT a pulse Continue CPR while

is present defibrillator is charging

1. Continue CPR until the defibrillator has been charged.

o Turn oxygen away from the patient's chest OR turn it off.

o Make sure the source of oxygen is removed from the patient when you
clear to shock.

o Check to see that no caregivers are touching the patient.

o Shock. If using biphasic, use manufacturer recommended dosage.

Press the shock button.

2. Immediately resume CPR for 5 cycles.

3. If IV/IO is available, administer Epinephrine 1mg IV/IO during the CPR cycle (see
drug administration in PDF file on right).

4. Check rhythm in less than 10 seconds.

5. If a shockable rhythm is present, give 1 shock.

o Continue CPR while the defibrillator is charging.

o Clear the patient for shock .

o Deliver the shock.

 o Resume CPR immediately after shock, 5 cycles.

Following the sequence in the algorithm is the best scientific approach to restore
spontaneous circulation.