Reach out to your Members of Congress to make your voice heard about why this issue matters to you. Look up your Representative in the U.S. House of Representatives here and find information about your Senators here. POCUS may be useful to diagnose treatable causes of cardiac arrest such as cardiac tamponade and pneumothorax. Right ventricular dilation in isolation during cardiac arrest should not be used to diagnose massive pulmonary embolism. Consider intraosseous (IO) access if attempts at IV access are unsuccessful or IV access is not feasible. All hospital staff should be able to rapidly recognise cardiac arrest, call for help, start CPR and defibrillate (attach an AED and follow the AED prompts, or use a manual defibrillator).

The guidelines recognise the increasing role of point-of-care ultrasound (POCUS) in peri-arrest care for diagnosis, but emphasises that it requires a skilled operator, and the need to minimise interruptions during chest compression. Use direct or video laryngoscopy for tracheal intubation according to local protocols and rescuer experience. Hospitals should review cardiac arrest events to identify opportunities for system improvement and share key learning points with hospital staff. During CPR, start with basic airway techniques and progress stepwise according to the skills of the rescuer until effective ventilation is achieved. If an advanced airway is required, only rescuers with a high tracheal intubation success rate should use tracheal intubation. The expert consensus is that a high success rate is over 95% within two attempts at intubation.

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If atropine is ineffective and transcutaneous pacing is not immediately available, fist pacing can be attempted while waiting for pacing equipment.

Emergency medical systems (EMS) should consider implementing criteria for the withholding and termination of resuscitation (TOR) taking into consideration specific local legal, organisational and cultural context ( see the Ethics Guidelines).Lidocaine 100 mg IV (IO) may be used as an alternative if amiodarone is not available or a local decision has been made to use lidocaine instead of amiodarone. An additional bolus of lidocaine 50 mg can also be given after five defibrillation attempts. Resuscitation team members should have the key skills and knowledge to manage a cardiac arrest including manual defibrillation, advanced airway management, intravenous access, intra-osseous access, and identification and treatment of reversible causes. Hospitals should have a clear policy for the clinical response to abnormal vital signs and critical illness. This may include a critical care outreach service and/or emergency team (e.g. medical emergency team, rapid response team).

myocardial ischaemia – may present with chest pain (angina) or may occur without pain as an isolated finding on the 12-lead ECG (silent ischaemia). An increase in ETCO 2 during CPR may indicate that ROSC has occurred. However, chest compression should not be interrupted based on this sign alone. During manual chest compressions, ‘hands-on’ defibrillation, even when wearing clinical gloves, is a risk to the rescuer. Use data-driven, performance-focused debriefing of rescuers to improve CPR quality and patient outcomes.Minimise the risk of fire by taking off any oxygen mask or nasal cannulae and place them at least 1 m away from the patient’s chest. Ventilator circuits should remain attached. Hospitals should train staff in the recognition, monitoring and immediate care of the acutely ill patient. After dealing 50,000 damage, create an explosion centered [ sic] on your current target, dealing up to 40% per rank weapon damage [ sic] to nearby enemies. Adult patients with non-traumatic OHCA should be considered for transport to a recognised centre of care for appropriate specialist treatment, according to local protocols. There is no evidence to express a preference for a policy of primarily transporting via ambulance (using bypass protocols) or one of secondary inter-hospital transfer. This is achieved by continuing chest compressions during defibrillator charging, delivering defibrillation with an interruption in chest compressions of less than 5 seconds and then immediately resuming chest compressions.