Move to advanced cardiac life support (ACLS).
A.
Proceed with ACLS or pediatric advanced life support (PALS) protocol. Multiple providers are required at this stage.
B.
Provide high quality cardiopulmonary resuscitation (CPR), initiating mechanical chest compression. If available and as soon as is feasible, defibrillate the patient if shockable rhythm (VF or pVT).
C.
Manage the airways if there is no previous advanced airway on site. Provide mask or handbag ventilation in the meantime.
D.
If the airway is available, provide controlled mechanical ventilation (MV) with 100% fraction of impaired oxygen (FiO2).
E.
Administer medications as suggested by the most recent ACLS/PALS protocol.
F.
If possible, have a team leader guide the scenario and record.
G.
Consider ECMO-related causes of cardiac arrest:
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- Acute circuit thrombosis with No Flow scenario.
- Severe membrane lung (ML) failure with severe hypoxemia.
- Gas supply interruption with severe hypoxemia/respiratory acidosis.
- Accidental decannulation with massive hypovolemia due to exsanguination.
- Massive circuit air entrance with air-lock.
- Cardiac tamponade as a cannulation complication.
H.
Consider other reversible causes of intrahospital cardiac arrest.
- Electrolytes abnormalities
- Metabolic disturbances
- Medications-related arrhythmia
- Cardiac tamponade
- Tension pneumothorax
- Acute myocardial infarction
- Pulmonary embolism
I.
Treat the immediately reversible potential cause(s) if or as detected.
J.
Plan emergent treatment of the potential causes requiring cath lab or surgery if/as detected.
K.
Keep the patient's family informed.
Is there a return of spontaneous circulation (ROSC)?