What is AHA treatment algorithm for ventricular tachycardia (VT)?

Updated: Dec 05, 2017
  • Author: Steven J Compton, MD, FACC, FACP, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

The following summarizes the AHA adult cardiac arrest algorithm for ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) [60] :

  • Activate the emergency response system.
  • Initiate cardiopulmonary resuscitation (CPR) and give oxygen when available.
  • Verify the patient is in VF as soon as possible (ie, automated external defibrillator [AED] and quick look with paddles).
  • Defibrillate once: Use a device specific recommendations (ie, 120-200 J for biphasic waveform; 360 J for monophasic waveform); if unknown, use the maximum available.
  • Resume CPR immediately without pulse check and continue for 5 cycles. One cycle of CPR equals 30 compressions and 2 breaths; 5 cycles of CPR should take roughly 2 minutes (compression rate 100 per minute). Do not check for rhythm/pulse until 5 cycles of CPR are completed.
  • During CPR, minimize interruptions while securing intravenous (IV) access and performing endotracheal intubation. Once the patient is intubated, continue CPR at 100 compressions per minute without pauses for respirations, and administer respirations at 10 breaths per minute.
  • Check rhythm after 2 minutes of CPR.
  • Repeat a single defibrillation if rhythm check still reveals VF/pVT. Selection of fixed versus escalating energy for subsequent shocks is based on the specific manufacturer’s instructions. For a manual defibrillator capable of escalating energies, higher energy for the second and subsequent shocks may be considered.
  • Resume CPR for 2 minutes immediately after defibrillation.
  • Continuously repeat the cycle of (1) rhythm check, (2) defibrillation, and (3) 2 minutes of CPR.
  • Administer a vasopressor: Give a vasopressor during CPR before or after the shock when IV or intraosseous (IO) access is available. Administer epinephrine 1 mg every 3-5 minutes.
  • Administer antidysrhythmics: Give antidysrhythmic agents during CPR before or after the shock. Administer amiodarone 300 mg IV/IO once; then, consider administering an additional 150 mg once.

In addition, correct the following if necessary and/or possible:

  • Hypovolemia
  • Hypoxia
  • Hydrogen ion (acidosis): Consider bicarbonate therapy.
  • Hyperkalemia/hypokalemia and metabolic disorders
  • Hypoglycemia: Check fingerstick or administer glucose.
  • Hypothermia: Check core rectal temperature.
  • Toxins
  • Tamponade, cardiac: Check with ultrasonography.
  • Tension pneumothorax: Consider needle thoracostomy.
  • Thrombosis, coronary or pulmonary: Consider thrombolytic therapy if suspected.
  • Trauma

According to the AHA, if all the following factors are present, termination of resuscitation in out-of-hospital cardiac arrest (OHCA) may be considered [60] :

  • Arrest was not witnessed by emergency medical services (EMS) personnel
  • No return of spontaneous circulation (ROSC) prior to transport
  • No AED shock delivered prior to transport

In addition, in intubated patients, failure to achieve an end-tidal carbon dioxide (ETCO2) over 10 mm Hg by waveform capnography after 20 minutes of CPR may be considered as one component of a multimodal approach to decide when to end resuscitative efforts. However, no studies of nonintubated patients have been reviewed and ETCO2 should not be used as an indication to end resuscitative efforts.


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