ACLS Algorithms: Free Printable PDFs

Adult Cardiac Arrest Algorithm

Last reviewed October 19, 2026 · Based on ILCOR and AHA guidelines 2025-2030

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1
Start CPR
Then check the rhythm. Shockable (VF/pVT): go to step 2. Nonshockable (asystole/PEA): go to step 9.
- Begin high-quality chest compressions
- Provide bag-mask ventilation with oxygen
- Connect the patient to a monitor/defibrillator
VF/pVT
The rhythm is shockable.
Deliver shock
4
Resume CPR for 2 minutes
Then check the rhythm. Shockable: go to step 5. Not shockable: go to step 13.
- Establish IV/IO access
Deliver shock
6
Resume CPR for 2 minutes
Then check the rhythm. Shockable: go to step 7. Not shockable: go to step 13.
- Administer epinephrine every 3-5 minutes
- Consider advanced airway placement and waveform capnography
Deliver shock
8
Resume CPR for 2 minutes
Then return to the rhythm check before step 5.
- Administer amiodarone or lidocaine
- Identify and treat reversible causes (H’s and T’s)
Asystole/PEA
The rhythm is not shockable.
Give epinephrine immediately
11
Resume CPR for 2 minutes
Then check the rhythm. Shockable: go to step 5. Not shockable: go to step 12.
- Establish IV/IO access
- Administer epinephrine every 3-5 minutes
- Consider advanced airway placement and waveform capnography
12
Resume CPR for 2 minutes
Then check the rhythm. Shockable: go to step 5. Not shockable: go to step 13.
- Identify and treat reversible causes (H’s and T’s)
13
Assess for ROSC
- If there are no signs of ROSC, go to step 11
- If ROSC is present, go to post-cardiac arrest care
- Evaluate whether further resuscitation is appropriate

Depth: compress at least 2 inches (5 cm); avoid depths over 2.4 inches (6 cm)
Rate: deliver 100-120 compressions/min, allowing full chest recoil after each compression
Minimize chest compression interruptions
Switch the rescuer performing compressions every 2 minutes (or earlier if tired)
Avoid excessive ventilation: do not give breaths too frequently or use excessive tidal volumes
Without an advanced airway: use a ratio of 30 compressions to 2 breaths (30:2)
With an advanced airway: provide 1 breath every 6 seconds (10 breaths/min) without pausing chest compressions
Use continuous waveform capnography. If ETCO₂ is low or falling, reassess CPR quality

Airway options: endotracheal intubation (ETI) or a supraglottic airway (SGA)
Confirm correct ET tube placement and monitor its position using continuous waveform capnography or capnometry

Biphasic, first shock: select the energy recommended by the manufacturer (e.g., 120-200 J). If the recommendation is unknown, use the device’s maximum energy setting
Biphasic, subsequent shocks: maintain the previous energy level. Consider increasing it according to the manufacturer’s guidance
Monophasic: use 360 J for each shock

H’s: hypovolemia, hypoxia, hydrogen ion (acidosis), hypo- or hyperkalemia, hypothermia
T’s: tension pneumothorax, tamponade (cardiac), toxins, thrombosis (pulmonary), thrombosis (coronary)