• As a minimum, the following resuscitation equipment should be available in every primary healthcare practice:
• Oxygen mask with reservoir bag
• Pocket mask and one-way valve
• Oropharyngeal (Guedel) airway or laryngeal mask airway (only for use by people with appropriate training and experience)
• Automated external defibrillator with electrodes and razor (to shave the area intended for electrode placement). A manual defibrillator is also appropriate provided that the rescuer is trained in basic rhythm recognition, and that they are confident in recognizing shockable, non-shockable, and potentially-perfusing rhythms.
• Syringe and needles
• Intravenous cannulae
• Oxygen
• Adrenaline
• Amiodarone
• Atropine
• Tape
• Gloves
• Sharps box
• Scissors
• Saline flush
• Tissues

• Diagnose cardiac arrest if the person is unresponsive and not breathing normally.
• Ensure that it is safe to approach the person.
• Check the person for a response — gently shake their shoulders and ask loudly, 'Are you all right?'
• If there is no response, check whether breathing is normal:
• Shout for help.
• Ask anyone who comes to assist to dial 999 and ask for an ambulance, fetch a defibrillator, and then to come back to help.
• Open the airway by turning the person onto their back, and:
• Place your hand on the person's forehead and gently tilt their head back.
• With your fingertips under the point of the person's chin, lift the chin to open the airway.
• Check whether the person is breathing normally whilst keeping the airway open:
• Look for chest movement.
• Listen at the person's mouth for breath sounds.
• Put your face close to their mouth, and feel for air on your cheek.
• Look, listen, and feel for no more than 10 seconds to determine if the person is breathing normally. If there is any doubt whether breathing is normal, act as if it is not normal.
• Agonal gasps (infrequent, irregular breaths) are common in the first few minutes after sudden cardiac arrest; they should not be considered to be normal breathing.
• If there is no response and the person is not breathing normally:
• Call an ambulance if one has not already been called.
• Ask someone to call for one, or
• If you are on your own, do this yourself; you may need to leave the person.
• Start cardiopulmonary resuscitation if a defibrillator is not immediately available.
• As soon as a defibrillator is available assess the rhythm by applying paddles or self-adhesive patches to the chest and manage accordingly.

• Continue cardiopulmonary resuscitation (CPR) until a defibrillator is available.
• As soon as a defibrillator is available, assess the rhythm by applying self-adhesive patches to the chest.
• Give uninterrupted chest compressions whilst patches are applied.
• Attempt defibrillation if ventricular fibrillation (VF) or ventricular tachycardia (VT) is identified (see Shockable rhythm - management).
• Do NOT attempt defibrillation if asystole or pulseless electrical activity (PEA) is identified; start or continue CPR (see Non-shockable rhythm - management).
• If there is doubt about whether the rhythm is asystole or fine VF, do NOT attempt defibrillation (see Non-shockable rhythm - management).
• If an automated external defibrillator is used, follow the voice and visual prompts regarding whether to shock the person or not.

• Attempt defibrillation if ventricular fibrillation (VF) or ventricular tachycardia (VT) is identified.
• Start defibrillation immediately if the cardiac arrest was witnessed by a healthcare professional and a defibrillator is immediately available.
• Give cardiopulmonary resuscitation (CPR) for 2 minutes (about five cycles at a ratio of 30 compressions to two rescue breaths) before starting defibrillation if the cardiac arrest was not witnessed by a healthcare professional or a defibrillator is not immediately available.
• Attempt defibrillation (one shock: 150–200 J biphasic or 360 J monophasic).
• If using an automated external defibrillator, the machine will automatically choose the correct strength for each shock.
• Immediately resume CPR (with a 30:2 ratio of compressions to rescue breaths) without reassessing the rhythm or feeling for a pulse. Without interrupting CPR:
• Attempt to gain venous access as soon as possible.
• Secure the airway by a supraglottic airway device (such as laryngeal mask airway [LMA]), or a tracheal tube for those who have experience in tracheal intubation.
• Once the airway is secured, ventilate the lungs at a rate of about 10 breaths per minute and continue chest compressions without pausing during ventilation.
• The lungs may also be ventilated by means of a pocket mask or bag-valve-mask device (BVMD) with or without an oropharyngeal airway (OPA), but it should be noted that this method does not secure the airway against the aspiration of regurgitated gastric contents.
• If an oropharyngeal airway (Guedel airway) or nasopharyngeal device is used, continue CPR with a 30:2 ratio of compressions to rescue breaths.
• Continue CPR for 2 minutes, then pause briefly to check the monitor:
• If VF/VT persists:
• Give a further (second) shock (150–360 J biphasic or 360 J monophasic).
• Resume CPR immediately and continue for 2 minutes.
• Pause briefly to check the monitor.
• If VF/VT persists, give adrenaline 1 mg intravenously (IV) followed immediately by a (third) shock (150–360 J biphasic or 360 J monophasic).
• Resume CPR immediately and continue for 2 minutes.
• Pause briefly to check the monitor.
• If VF/VT persists, give amiodarone 300 mg IV followed immediately by a (fourth) shock (150–360 J biphasic or 360 J monophasic). If amiodarone is not available, give lidocaine 1 mg/kg (but not if amiodarone has been given already).
• Resume CPR immediately and continue for 2 minutes.
• Continue to give a further shock after each 2 minute period of CPR and after confirming that VF/VT persists.
• Give adrenaline 1 mg IV immediately before alternate shocks (i.e. approximately every 3–5 minutes).
• If organized electrical activity is seen, check for a pulse or other sign of life (such as movement).
• If a pulse or other sign of life is present, start post-resuscitation care.
• If no pulse or other sign of life is present, continue CPR and manage as for non-shockable cardiac arrest.
• If asystole is seen, continue CPR and manage as for non-shockable cardiac arrest.
• Identify any potentially reversible causes of cardiac arrest and manage as appropriate.

For pulseless electrical activity (PEA):

• Start cardiopulmonary resuscitation (CPR) at a ratio of 30 compressions to two rescue breaths.
• Without stopping CPR, gain venous access as soon as possible.
• Give adrenaline 1 mg intravenously (IV) as soon as venous access is achieved.
• Continue CPR (with a 30:2 ratio of compressions to rescue breaths) until the airway is secured by a supraglottic airway device (such as laryngeal mask airway [LMA]), or a tracheal tube for those who have experience in tracheal intubation.
• Once the airway is secured, ventilate the lungs at a rate of about 10 breaths per minute and continue chest compressions without pausing during ventilation.
• The lungs may also be ventilated by means of a pocket mask or bag-valve-mask device (BVMD) with or without an oropharyngeal airway (OPA), but it should be noted that this method does not secure the airway against the aspiration of regurgitated gastric contents.
• If an oropharyngeal airway (Guedel airway) or nasopharyngeal device is used, continue CPR with a 30:2 ratio of compressions to rescue breaths.
• Recheck the rhythm after 2 minutes.
• If there is no change in the ECG appearance on the defibrillator monitor:
• Continue CPR.
• Recheck the rhythm after 2 minutes.
• If there is no change in the ECG appearance, give adrenaline 1 mg IV.
• Continue giving CPR, checking the rhythm every 2 minutes and giving further adrenaline 1 mg IV every 3–5 minutes (alternate loops).
• If the ECG changes and organized electrical activity is seen, check for a pulse:
• If no pulse is present, continue CPR. Recheck the rhythm after 2 minutes and proceed accordingly; give further adrenaline 1 mg IV every 3–5 minutes (alternate loops).

For asystole and slow PEA (rate less than 60/minute):

• Start cardiopulmonary resuscitation (CPR) at a ratio of 30 compressions to two rescue breaths.
• Without stopping CPR, gain venous access as soon as possible.
• Give adrenaline 1 mg IV as soon as venous access is achieved.
• Continue CPR (with a 30:2 ratio of compressions to rescue breaths) until the airway is secured (for example, by tracheal intubation [should only be performed by those who have undergone extensive training and who practice the skills regularly] or alternative airway device).
• Once an airway device has been inserted, ventilate the lungs at a rate of about 10 breaths per minute and continue chest compressions without pausing during ventilation.
• Recheck the rhythm after 2 minutes:
• If there is no change in the ECG appearance on the defibrillator monitor:
• Continue giving CPR, checking the rhythm every 2 minutes and giving further adrenaline 1 mg IV every 3–5 minutes (alternate loops).
• If ventricular fibrillation or ventricular tachycardia recurs, manage as for shockable rhythm.
• If organized electrical activity is seen, check for a pulse or other signs of life (such as movement).
• If no pulse or other sign of life is present, continue CPR. Recheck the rhythm after 2 minutes and proceed accordingly. Give further adrenaline 1 mg IV every 3–5 minutes (alternate loops).

Identify any potentially reversible causes of cardiac arrest and manage as appropriate.

• Start chest compressions:
• Kneel by the side of the person.
• Place the heel of one hand in the centre of the person's chest.
• Place the heel of your other hand on top of the first hand.
• Interlock the fingers of your hands and ensure that pressure is not applied over the person's ribs. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone).
• Position yourself vertically above the person's chest and, with your arms straight, press the sternum down by 5–6 cm.
• After each compression, release all the pressure on the chest without losing contact between your hands and the sternum.
• Repeat at a rate of 100–120 times a minute (about two compressions a second).
• Compression and release should take an equal amount of time.
• If a crack is heard or felt during compressions (indicating a fracture to the costal cartilage or ribs) continue with chest compressions, having checked that your hands are in the correct position.
• Combine chest compressions with rescue breaths:
• After 30 chest compressions, open the airway again:
• Place your hand on the person's forehead and gently tilt their head back.
• With your fingertips under the point of the person's chin, lift the chin to open the airway.
• Pinch the soft part of the person's nose closed, using the index finger and thumb of the hand on their forehead.
• Allow their mouth to open, but maintain chin lift.
• Take a normal breath and place your lips around the mouth, making sure that you have a good seal.
• Blow steadily into the mouth whilst watching for the chest to rise. Take about 1 second to make the chest rise as in normal breathing; this is an effective rescue breath.
• Maintaining head tilt and chin lift, take your mouth away and watch for the chest to fall as air comes out.
• Take another normal breath and blow into the person's mouth once more to give a total of two effective rescue breaths.
• Without delay, return your hands to the correct position on the sternum and give a further 30 chest compressions.
• Continue with chest compressions and rescue breaths in a ratio of 30:2.
• Stop to recheck the person only if they start breathing normally or show other signs of life (such as moving, speaking, opening their eyes); otherwise do not interrupt resuscitation.