Tension pneumothorax Tamponade (cardiac) Toxins Thrombosis (coronary or pulmonary)
Capnography is mandatory once intubated: confirms tube position, gauges CPR quality, and a sudden rise in ETCO₂ suggests ROSC. Persistently <1.3 kPa (10 mmHg) after 20 min is a poor prognostic sign.
Ultrasound during the rhythm check helps identify tamponade, hypovolaemia, PE and pneumothorax — without extending the pause.
Special circumstances
Anaphylaxis: adrenaline 500 µg IM (0.5 ml of 1:1000); under anaesthesia with IV access, 50 µg IV boluses. Remove the trigger, fluids, then chlorphenamine and hydrocortisone as second line. Mast cell tryptase immediately, at 1–2 h, and a baseline at 24 h.
Local anaesthetic toxicity: stop injecting, 100% oxygen, control seizures, 20% lipid emulsion 1.5 ml/kg then 15 ml/kg/h. Avoid lidocaine and vasopressin; use small adrenaline doses. Prolonged resuscitation may be needed.
Hyperkalaemia: calcium chloride/gluconate to stabilise the myocardium, insulin-dextrose and salbutamol to shift, dialysis to remove.
Hypothermic arrest: "not dead until warm and dead". Withhold drugs below 30 °C; limit to 3 shocks below 30 °C. Rewarm actively, consider ECMO.
Pregnancy: manual left uterine displacement, early airway control, and perimortem caesarean section within 5 minutes if no ROSC after 4 minutes — done for the mother's benefit, to relieve aortocaval compression.
Massive PE: consider thrombolysis and continue CPR for 60–90 minutes afterwards.
Post-resuscitation care
Targeted temperature management — avoid fever, maintain 32–36 °C for at least 24 hours in comatose survivors.
Normoxia and normocapnia — titrate FiO₂ to SpO₂ 94–98%; hyperoxia worsens reperfusion injury.
Coronary angiography if a cardiac cause is suspected · glycaemic control · seizure treatment · delay prognostication for at least 72 hours.
Guidance follows current ERC/Resuscitation Council principles. Always check the live algorithm before an exam — the details are periodically revised.