Launched on 6th of October 2026

Cardio.toolsby Mohamed Ghazy, MD CardiologyAin Shams University, Egypt · Cardiology Consultant, Saudi ArabiaScopus ID: 55257919100
Cardiac arrest: adult ACLS

Adult cardiac arrest: CPR and ACLS with code timer

Runs the adult cardiac arrest algorithm at the bedside in the emergency room. A code timer tracks total time, the 2-minute CPR cycle and the time since the last epinephrine dose, and logs every shock and drug. It tells the team what is due next under the AHA 2025 ACLS algorithm (epinephrine after the second shock, amiodarone or lidocaine after the third) or the ERC 2025 ALS algorithm (epinephrine and amiodarone after the third shock), with early epinephrine in PEA and asystole, refractory VF options (vector change, double sequential defibrillation, ECPR), CPR quality targets and targeted treatment of the reversible causes.

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Guideline
The drug timing differs slightly between the AHA and ERC algorithms
Code timer
Tap each event as it happens; the timer starts with the first one. Alarms: pulse check every 2 min, epinephrine every 3–5 min. The code keeps running on other pages and after a reload, until ROSC, Stop CPR or Reset
Total
00:00
CPR cycle
00:00
Since epi
—
Shocks 0Epinephrine 0 mgAmiodarone 0 mg
Save / print: on this device only, nothing is uploaded
Reversible causes: 4 Hs and 4 Ts
Tick the causes you suspect for the targeted treatment
12-lead ECG as soon as possible
Bedside echo without interrupting CPR
⚠ Alteplase 50 mg IV over 2 minutesAnother 50 mg may be given after 15 minutes. Continue CPR for 60–90 minutes if no ROSC (ERC).ERC 2021 special circumstances; ESC 2019 PE
High-quality CPR
Check at every cycle
  • Rate 100–120/min, depth 5–6 cm, full recoil, hands in the centre of the chest.
  • Minimise pauses: under 10 s for rhythm checks and under 5 s around a shock; chest compression fraction above 80%.
  • 30:2 without an advanced airway; with one, continuous compressions and 1 breath every 6 s (10/min). Avoid hyperventilation.
  • ETCO₂ below 10 mmHg (1.3 kPa): improve compression quality. A sudden sustained rise to 35–40 mmHg suggests ROSC.
  • Switch the compressor every 2 minutes. Consider a mechanical device for transport, PCI or prolonged CPR.
Adult cardiac arrest · AHA 2025
CPR
No rhythm check yet
  • Start high-quality CPR now
    IAHA 2025
    Call the arrest team, give oxygen, attach the defibrillator pads without stopping compressions, then check the rhythm.

Epinephrine 1 mg = 10 mL of 1:10,000 (0.1 mg/mL). Flush every drug with 20 mL and elevate the limb. Consider stopping only after a team decision that includes duration, rhythm, ETCO₂, reversible causes and the patient's wishes.

References
  1. American Heart Association. 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 9: Adult advanced life support. Circulation 2025;152(suppl 2).
  2. European Resuscitation Council Guidelines 2025: Adult advanced life support. Resuscitation 2025.
  3. Kudenchuk PJ, et al. Amiodarone, lidocaine, or placebo in out-of-hospital cardiac arrest (ALPS). N Engl J Med 2016;374:1711-1722.
  4. Perkins GD, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest (PARAMEDIC2). N Engl J Med 2018;379:711-721.
  5. Cheskes S, et al. Defibrillation strategies for refractory ventricular fibrillation (DOSE-VF). N Engl J Med 2022;387:1947-1956.
  6. Lott C, et al. European Resuscitation Council Guidelines 2021: cardiac arrest in special circumstances (pulmonary embolism: thrombolysis, e.g. alteplase 50 mg IV over 2 min, then CPR for 60–90 min). Resuscitation 2021;161:152-219.
  7. Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism. Eur Heart J 2020;41:543-603.
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