# Adult cardiac arrest

Use the OCEMS arrest sequence, track medication totals, and coordinate post-ROSC destination.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/adult-cardiac-arrest/
Official source: [SO-C-010 — Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic](https://www.ochealthinfo.com/sites/hca/files/2021-06/SO-C-10%20Cardopulmonary%20Arrest%20-%20AdultAdolescent%20Non-Traumatic%20%2810-1-2021%29%20-%20Revised.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- This is the OCEMS local sequence, not a substitute for the complete resuscitation policy.
- Base contact is required for CVRC destination after ROSC; adult push-dose epinephrine authorization is governed by current PR-230.

## Source documents

- [SO-C-010 — Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic](https://www.ochealthinfo.com/sites/hca/files/2021-06/SO-C-10%20Cardopulmonary%20Arrest%20-%20AdultAdolescent%20Non-Traumatic%20%2810-1-2021%29%20-%20Revised.pdf)
- [PR-025 — Passive Ventilation Procedure](https://www.ochealthinfo.com/sites/hca/files/import/data/files/76427.pdf)
- [PR-230 — Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2026-01/PR-230%20Push%20Dose%20Epi%201-2026.pdf)

## Organize the first cycles

- Use a coordinated CPR approach with minimal compression interruptions and compressor rotation about every 2 minutes. Follow the source’s initial 200-compression/about-2-minute assessment sequence.
- Support oxygenation/ventilation with the indicated airway method. Passive ventilation is limited to its own witnessed-arrest procedure; do not apply it without its criteria. Obtain IV/IO without interrupting compressions.

## Shockable rhythm

- For coarse VF/pulseless wide-complex tachycardia, follow the source’s shock steps at maximum energy or the programmed/manufacturer-recommended setting, with CPR between assessments.
- The local source treats fine VF differently: continue CPR for another 2 minutes and reassess; persistent fine VF follows its PEA/asystole instructions.
- For persistent shockable arrest, epinephrine is 1 mg IV/IO using 0.1 mg/mL every approximately 3–5 minutes. Amiodarone is 300 mg IV/IO, then 150 mg in approximately 3–5 minutes if indicated; alternative lidocaine is 1 mg/kg, then 0.5 mg/kg once.

## PEA / asystole and later care

- Continue CPR, ventilation, IV/IO access, and epinephrine 1 mg every approximately 3–5 minutes. Assess reversible causes. The source lists 250 mL saline boluses up to 1 L; reassess lungs and stop saline if rales develop after ROSC.
- At the source’s 10-minute step, follow its airway and sodium-bicarbonate instructions: 50 mL of either 7.5% or 8.4% solution IV/IO. Keep the solution concentration and volume explicit.
- At 20 minutes without ROSC, the source lists continued scene care, transport, or base contact; at 30 minutes select transport or base contact for further orders/pronouncement consideration.

## ROSC and movement

- After ROSC, ventilate/oxygenate, address reversible problems, obtain a 12-lead when possible, and contact base for CVRC destination.
- Follow the complete policy for mechanical compression during movement/transport, advanced airway timing, implanted devices, and other special circumstances. Report rhythm, shocks, ETCO₂, cumulative medications, and ROSC time.