Adult ECAT protocol

Cardiorespiratory arrest

A3.1 Published: December 2023 Printed on 19 May 2024

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Any person, 16 years and over, presenting as unresponsive and not breathing normally.

Escalate immediately as per local CERS protocol.

This protocol is intended to be used by registered and enrolled nurses within their scope of practice and as outlined in The Use of Emergency Care Assessment and Treatment Protocols (PD2024_011). Sections marked triangle or diamond indicate the need for additional prerequisite education prior to use. Check the medication table for dose adjustments and links to relevant reference texts.

In all cases, commence basic life support (BLS) until an advanced life support (ALS) accredited clinician arrives.

This protocol authorises ALS accredited nurses only to request diagnostics and give medication and fluids as indicated below.

History prompts, signs and symptoms

These are not exhaustive lists. Maintain an open mind and be aware of cognitive bias.

History prompts

  • Onset of symptoms
  • Preceding events, e.g. collapse, trauma
  • Time of arrest
  • Time CPR commenced
  • Initial cardiac rhythm, if known
  • Pre-hospital treatment
  • Past admissions
  • Medical and surgical history
  • Current medications
  • Known allergies

Signs and symptoms

  • Unresponsive
  • Inadequate respiratory effort or apnoeic
  • Cyanosis
  • Pulseless

Basic life support (BLS)

Commence BLS until an ALS accredited clinician can take over care.

Advanced life support (ALS)

Follow the ANZCOR Adult Advanced Life Support flowchart and refer to the interventions and diagnostics section and medications section on this protocol for authorisation.

Start CPR. 30 compressions, 2 breaths. Minimise interruptions. Attach defibrillator / monitor. Assess rhythm. If shockable, shock and then CPR for 2 minutes. If non-shockable, CPR for 2 minutes. If return of spontaneous circulation, then post resuscitation care.
Reproduced with permission from the Australian Resuscitation Council.

Interventions and diagnostics

Specific treatment

  • Consider family discussion, need for social worker or religious leader.

Radiology

  • If return of spontaneous circulation (ROSC): CXR

Pathology

  • FBC, UEC, troponin, Ca/Mg/PO4, VBG, glucose

Medications

The shaded sections in this protocol are only to be used by registered nurses who have completed the required education.

Drag the table right to view more columns or turn your phone to landscape

Drug Dose Route Frequency

Adrenaline (epinephrine)

1 mg
(10 mL of 1:10,000)

IV/intraosseous

Shockable rhythm: after 2nd shock, then repeat every 2nd cycle

Non–shockable rhythm: immediately, then repeat every 2nd cycle

Amiodarone

300 mg

IV/intraosseous

Shockable rhythm: once only after 3rd shock

Glucose 5%

10 mL

IV/intraosseous

As required to flush amiodarone

Oxygen

2–15 L/min, device dependent

Inhalation

Continuous

Medications with contraindications or requiring dose adjustment are marked:

  • H for patients with known hepatic impairment
  • R for patients with known renal impairment.

Escalate to medical or nurse practitioner.

References

  • Australian and New Zealand Committee on Resuscitation [ANZCOR]. Protocols for Adult Advanced Life Support. Australia, ANZCOR; 2023 [cited 12 October 2023]. Available from: https://www.anzcor.org/
  • Beasley R, Chien J, Douglas J, et al. Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: 'Swimming between the flags'. Respirology. 2015 Nov;20(8):1182-91. DOI: 10.1111/resp.12620
  • Craig S, Cubitt M, Jaison A, et al. Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine. Medical Journal of Australia. 2020;213(3):126-33. Available from: https://doi.org/10.5694/mja2.50699
  • NSW Emergency Care Institute. Cardiac Arrest. Australia, NSW Health, Agency for Clinical Innovation; 2017 [cited 2 Feb 2023]. Available from: https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/cardiology/cardiac-arrest
  • NSW Health. Australian Medicines Handbook. Australia: Australian Government, NSW; 2022 [cited 13 Apr 2022]. Available from: https://amhonline.amh.net.au.acs.hcn.com.au/

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Evidence informed

Information was drawn from evidence-based guidelines and a review of latest available research. For more information, see the development process.

Collaboration

This protocol was developed by the ECAT Working Group, led by the Agency for Clinical Innovation. The group involved expert medical, nursing and allied health representatives from local health districts across NSW. Consensus was reached on all recommendations included within this protocol.

Currency Due for review: Jan 2026. Based on a regular review cycle.
Feedback Email ACI-ECIs@health.nsw.gov.au

ECAT home pageGlossary

Accessed from the Emergency Care Institute website at https://aci.health.nsw.gov.au/ecat/adult/cardiorespiratory-arrest

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