EUROPEAN

RESUSCITATION
COUNCIL
Advanced Life Support

Unresponsive and
not breathing normally?

Call Resuscitation Team

CPR 30:2
Attach defibrillator/monitor
Minimise interruptions

Assess rhythm

Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)

1 Shock Return of
Minimise spontaneous
interruptions circulation

Immediately resume IMMEDIATE POST CARDIAC Immediately resume

CPR for 2 min ARREST TREATMENT CPR for 2 min
Minimise interruptions n Use ABCDE approach Minimise interruptions
n Aim for SaO of 94-98%
2
n Aim for normal PaCO
2
n 12 Lead ECG

n Treat precipitating cause

n  Targeted temperature

management

DURING CPR TREAT REVERSIBLE CAUSES

n E  nsure high quality chest compressions Hypoxia Thrombosis coronary or pulmonary
n  Minimise interruptions to compressions Hypovolaemia Tension pneumothorax
n  Give oxygen
Hypo-/hyperkalaemia/metabolic Tamponade cardiac
Hypothermia/hyperthermia Toxins
n  Use waveform capnography

n C  ontinuous compressions when advanced airway

in place CONSIDER
n  ascular access
V n U ltrasound imaging
(intravenous or intraosseous) n Mechanical chest compressions to facilitate transfer/treatment

n  ive adrenaline every 3-5 min

G n C oronary angiography and percutaneous coronary intervention
n  ive amiodarone after 3 shocks
G n E xtracorporeal CPR

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw Product reference: Poster_ALS_Algorithm_ENG_20150930
 EUROPEAN
RESUSCITATION
COUNCIL
In-hospital Resuscitation

Collapsed / sick patient

Shout for HELP & assess patient

No Signs of life? Yes

Call resuscitation team Assess ABCDE

Recognise & treat
Oxygen, monitoring, IV access

CPR 30:2
with oxygen and
airway adjuncts

Call resuscitation team

if appropriate

Apply pads/monitor
Attempt debrillation
if appropriate

Advanced Life Support

Handover to
when resuscitation
resuscitation team
team arrives

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw Product reference: Poster_ALS_IHCAT_Algorithm_ENG_20150930
 EUROPEAN
RESUSCITATION
COUNCIL
Newborn Life Support

(Antenatal counselling)
Team briefing and equipment check

Birth

Dry the baby

Maintain normal temperature
Start the clock or note the time

Assess (tone), breathing and heart rate

If gasping or not breathing:

Open the airway
Give 5 inflation breaths
Consider SpO2 ECG monitoring

Re-assess
If no increase in heart rate 60 s
look for chest movement
Maintain Temperature

At
If chest not moving: Acceptable All
Recheck head position pre-ductal SpO2 Times
Consider 2-person airway control 2 min 60 % Ask:
and other airway manoeuvres 3 min 70 % Do
Repeat inflation breaths 4 min 80 %
SpO2 monitoring ECG monitoring 5 min 85 % You
Look for a response 10 min 90 % Need
Help?

If no increase in heart rate

look for chest movement

When the chest is moving:

(Guided by oximetry if available)

If heart rate is not detectable

or very slow (< 60 min-1)
Start chest compressions
Increase oxygen

Coordinate compressions with PPV (3:1)

Reassess heart rate every 30 seconds

If heart rate is not detectable
or very slow (< 60 min-1)
consider venous access and drugs

Discuss with parents and debrief team

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw Product reference: Poster_NLS_Algorithm_ENG_20150930
 EUROPEAN
RESUSCITATION
COUNCIL Basic Life Support and
Automated External
Defibrillation (AED)
Unresponsive and
not breathing normally

Call Emergency Services

Give 30 chest compressions

Give 2 rescue breaths

Continue CPR 30:2

As soon as AED arrives -

switch it on and follow
instructions

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw Product reference: Poster_BLS_Algorithm_ENG_20150930
 EUROPEAN
RESUSCITATION Basic Life Support
with the use of an Automated
COUNCIL

External Defibrillator (AED)

Shake gently
Check response

Ask loudly: Are you all right?

If unresponsive Open airway & check for breathing

If unresponsive and
If breathing normally
not breathing normally

Turn into recovery position

Call 112, send someone to get an AED
Call 112
Continue to assess that breathing remains normal

Start chest compressions Place your hands in the centre of the chest
Deliver 30 chest compressions:
immediately - Press firmly at least 5 cm but no more than
6 cm deep
- Press at a rate of at least 100/min but no more
than 120/min
If trained and able combine chest compressions
with ventillations otherwise continue with
compression only CPR
- Seal your lips around the mouth
- Blow steadily until the chest rises
- Give next breath when the chest falls
Continue CPR 30 compressions to 2 ventilations

Follow the spoken/visual directions

As soon as AED arrives

Attach one pad below the left armpit
Switch on the AED & attach pads Attach the other pad below the right collar bone,
next to the breastbone
If more than one rescuer: do not interrupt CPR

Stand clear and deliver shock

If shock is indicated

Continue CPR

Follow AED instructions

Continue CPR unless you are certain the victim has recovered and starts to breathe normally.

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw Product reference: Poster_BLS_AutomatedExternalDefibrillator_Algorithm_ENG_20151001
 EUROPEAN
RESUSCITATION
COUNCIL
Paediatric Basic Life Support

Unresponsive?

Shout for help

Open airway

Not breathing normally?

5 rescue breaths

No signs of life?

15 chest compressions

2 rescue breaths
15 compressions

Call cardiac arrest team

or Paediatric ALS team 
after 1 minute of CPR

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw Product reference: Poster_PAEDS_BLS_ Algorithm_ENG_20150930
 EUROPEAN
RESUSCITATION Paediatric Advanced Life
COUNCIL
Support

Unresponsive?
Not breathing or
only occasional gasps

CPR (5 initial breaths then 15:2)

Attach debrillator/monitor Call Resuscitation Team
(1 min CPR rst, if alone)
Minimise interruptions

Assess rhythm

Shockable Non-shockable
(VF/Pulseless VT) (PEA/Asystole)

Return of
1 Shock 4 J/Kg spontaneous
circulation

Immediately resume: IMMEDIATE POST CARDIAC Immediately resume:

CPR for 2 min ARREST TREATMENT CPR for 2 min
Minimise interruptions n Use ABCDE approach
Minimise interruptions
At 3rd cycle and 5th cycle n Controlled oxygenation
consider amiodarone in and ventilation
shock-resistant VF/pVT
n Investigations

n Treat precipitating cause

n Temperature control

DURING CPR REVERSIBLE CAUSES

n E nsure high-quality CPR: rate, depth, recoil n  ypoxia
H
n  lan actions before interrupting CPR
P n  ypovolaemia
H
n  ive oxygen
G n  yper/hypokalaemia, metabolic
H
n  ascular access (intravenous, intraosseous)
V n  ypothermia
H
n  ive adrenaline every 3-5 min
G n T hrombosis (coronary or pulmonary)
n  onsider advanced airway and capnography
C n T ension pneumothorax
n  ontinuous chest compressions when
C n T amponade (cardiac)
advanced airway in place n T oxic/therapeutic disturbances
n  orrect reversible causes
C

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw Product reference: Poster_PAEDS_PALS_ Algorithm_ENG_20150930
 EUROPEAN
RESUSCITATION
COUNCIL
Anaphylaxis
Anaphylactic reaction?

Assess using ABCDE approach

Diagnosis - look for:

n Acute onset of illness
n Life-threatening Airway and/or
Breathing and/or Circulation problems1

n And usually skin changes

n Call for help

n Lie patient flat with raised legs (if breathing allows)

Adrenaline 2

When skills and equipment available:

n E stablish airway Monitor:
n High flow oxygen n P
 ulse oximetry
n I V fluid challenge 3 n E
 CG
n C hlorphenamine 4 n B
 lood pressure
n H ydrocortisone 5

Life-threatening problems:
1.

Airway: swelling, hoarseness, stridor

Breathing: rapid breathing, wheeze, fatigue, cyanosis, SpO2 < 92%, confusion
Circulation: p
 ale, clammy, low blood pressure, faintness, drowsy/coma

Adrenaline (give IM unless experienced with IV adrenaline)

2.
IV fluid challenge (crystalloid):
3.

IM doses of 1:1000 adrenaline (repeat after 5 min if no better) Adult 500 - 1000 mL
n Adult 500 mcg IM (0.5 mL) Child 20 mL kg-1
n Child more than 12 years 500 mcg IM (0.5 mL)
n Child 6-12 years 300 mcg IM (0.3 mL) Stop IV colloid if this might be the cause
n Child less than 6 years 150 mcg IM (0.15 mL)
of anaphylaxis
Adrenaline IV to be given only by experienced specialists
Titrate: Adults 50 mcg; Children 1 mcg kg-1

4.
Chlorphenamine 5.
Hydrocortisone
(IM or slow IV) (IM or slow IV)
Adult or child more than 12 years 10 mg 200 mg
Child 6 - 12 years 5 mg 100 mg
Child 6 months to 6 years 2.5 mg 50 mg
Child less than 6 months 250 mcg kg-1 25 mg

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw - Reproduced with permission from Elsevier Ireland Ltd.- license number 3674081014315
Product reference: Poster_SpecCircs_Anaphylaxis_ENG_20150930
 EUROPEAN
RESUSCITATION Avalanche Accident
COUNCIL

Assess patient at extrication

YES
Lethal injuries or Do not
whole body frozen start CPR

NO
60 min
( 30C)
Duration of burial Universal ALS
(core temperature) 1
algorithm 2

> 60 min (< 30C)

YES
Minimally invasive
Signs of life? 3
rewarming 4

NO

Start CPR 5 VF/pVT/PEA

Monitor ECG

YES
Asystole or
UNCERTAIN
Consider serum Hospital
Patent airway
potassium 6
with ECLS

NO
> 8 mmol L -1

Consider termination of CPR

1.
Core temperature may substitute if duration of burial is unknown
2.
Transport patients with injuries or potential complications (e.g. pulmonary oedema) to the most appropriate hospital
3.
Check for spontaneous breathing and pulse for up to 1 min
4.
Transport patients with cardiovascular instability or core temperature < 28C to a hospital with ECLS (extracorporeal life support)
5.
Withold CPR if risk to the rescue team is unacceptably high
6.
Crush injuries and depolarising neuromuscular blocking drugs may elevate serum potassium

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw Product reference: Poster_SpecCircs_ AvalancheAccident_Algorithm_ENG_20150930
 EUROPEAN
RESUSCITATION Drowning
COUNCIL

Unresponsive and
not breathing normally?

Shout for help and

call emergency services

Open airway

Give 5 rescue breaths / ventilations

supplemented with oxygen if possible

Signs of life?

Start CPR 30:2

Attach AED and

follow instructions

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw Product reference: Poster_SpecCircs_ Drowing_Algorithm_ENG_20150930
 EUROPEAN
RESUSCITATION Hyperkalaemia
COUNCIL

n Assess using ABCDE approach

n 12-lead ECG and monitor cardiac rhythm if serum potassium (K+) 6.5 mmol L-1
n Exclude pseudohyperkalaemia
n Give empirical treatment for arrhythmia if hyperkalaemia suspected

MILD MODERATE SEVERE

K+ 5.5 - 5.9 mmol L-1 K+ 6.0 - 6.4 mmol L-1 K+ 6.5 mmol L-1
Consider cause and Treatment guided by clinical Emergency treatment
need for treatment scenario, ECG and rate of rise indicated

Seek expert help

ECG changes?
n Peaked T waves n Broad QRS n Bradycardia
n Flat / absent P waves n Sine wave n VT

Protect IV calcium
the heart 10 mL 10% calcium chloride IV
OR 30 mL 10% calcium gluconate IV
n Use large IV access and give over 5-10 min
n Repeat ECG
n Consider further dose after 5 min if ECG changes persist

Insulinglucose IV infusion
Glucose (25 g) with 10 units soluble insulin over 15 min IV
25 g glucose = 50 mL 50% glucose OR 125 mL 20% glucose
Shift K +
Risk of hypoglycaemia
into
cells
Salbutamol 10-20 mg nebulised

Consider Consider dialysis

calcium resonium
Remove K+ 15 g x 4/day oral or Seek expert help
from body 30 g x 2/day per rectum

Monitor K+ Monitor serum potassium and blood glucose

K+ 6.5 mmol L-1
and blood
despite medical therapy
glucose

Consider cause of hyperkalaemia

Prevention
and prevent recurrence

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw - Reproduced with permission from Renal Association and Resuscitation Council (UK)
Product reference: Poster_SpecCircs_Hyperkalaemia_Algorithm_ENG_20150930
 EUROPEAN
RESUSCITATION Traumatic Cardiac Arrest
COUNCIL

Trauma patient

Cardiac arrest / 
Periarrest situation?

Consider Universal ALS

LIKELY
non-traumatic cause algorithm

Hypoxia UNLIKELY
Tension pneumothorax
Simultaneously address reversible causes
Continue ALS
Start /
Tamponade
Hypovolaemia

1. Control catastrophic haemorrhage

2. Control airway and maximise oxygenation
Elapsed time
3. Bilateral chest decompression
< 10 min since
4. Relieve cardiac tamponade arrest?
5. Surgery for haemorrhage control
Expertise?
or proximal aortic compression?
Equipment?
6. Massive transfusion protocol and fluids
Environment?

Consider immediate
Consider termination Return of spontaneous
NO resuscitative 
of CPR circulation?
thoracotomy

YES

Pre-hospital:
n Perform only life-saving interventions

n Immediate transport to appropriate hospital

In-hospital:
n Damage control resuscitation
n Definitive haemorrhage control

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Published October 2015 by European Resuscitation Council vzw, Emile Vanderveldelaan 35, 2845 Niel, Belgium
Copyright: European Resuscitation Council vzw Product reference: Poster_SpecCircs_TraumaticCardiacArrest_Algorithm_ENG_20150930