Adult advanced life support (ALS)
Adult in-hospital cardiac arrest aligned to the Resuscitation Council UK Guidelines 2025 Adult ALS algorithm: 30:2 CPR, shockable vs non-shockable arms, reversible causes, and immediate ROSC care.
RCUK Guidelines 2025
Adult advanced life support
Unresponsive with absent or abnormal breathing. This walkthrough follows the Resuscitation Council UK Adult ALS algorithm poster only. Drug milligram doses and shock energy are not on that poster: use your Trust trolley card and the full RCUK ALS manual.
Immediate
- Maintain personal safety
- Identify and treat reversible causes early
- Call resuscitation team / ambulance service
- CPR 30:2. Attach defibrillator
Assess rhythm
High-quality chest compressions and ventilations
- Ensure optimal defibrillator pad placement
- Give oxygen
- Continuous compressions if tracheal tube or SGA
- Use waveform capnography
- Minimise interruptions to chest compressions
- Early IV access (IO if IV not possible)
Reversible causes
- Hypoxia
- Hypovolaemia
- Hyper-hypokalaemia, -calcaemia, -magnesaemia, hypoglycaemia (metabolic)
- Hypo-hyperthermia
- Thrombosis (coronary / pulmonary)
- Tension pneumothorax
- Toxins
- Tamponade (cardiac)
Consider
- Changing pads to antero-posterior after 3 shocks
- Mechanical chest compressions to facilitate transfer / treatment
- Ultrasound to identify reversible causes
- Extracorporeal CPR and/or coronary angiography / PCI
Scope
- Unresponsive with absent or abnormal breathing.
- This topic restates the Resuscitation Council UK Guidelines 2025 Adult ALS algorithm poster. It is not a substitute for ALS training, the arrest team, or your Trust resuscitation policy.
- In hospital, calling the resuscitation team is usually the cardiac arrest call (often 2222). Confirm your site number.
- Milligram doses and defibrillation energy are not on this poster. Use the Trust ALS trolley card and the full RCUK ALS manual.
🔗 Related
Note Template
Ready-to-use clinical note structure
🕒 19 / 08 / 2026 — 02:18 ATRP re: adult cardiac arrest (RCUK ALS 2025) Patient: [age] [sex] Location: [ward / ED / other] Admission Dx: [reason for admission] Witnessed: [Y/N] Bystander CPR: [Y/N] 🧾 Event: • Unresponsive with absent or abnormal breathing: [Y/N] • Arrest call: [time] Team arrival: [time] • Initial rhythm: [VF / pulseless VT / PEA / asystole] • Shocks: [number] • Adrenaline: [after 3 shocks if shockable / then every 3–5 min if non-shockable] • Amiodarone: [after 3 shocks / not given] • Airway: [BVM / SGA / tracheal tube]; waveform capnography [Y/N] • Access: [IV / IO] 🔄 Reversible causes considered: • Hypoxia / hypovolaemia / metabolic (K, Ca, Mg, glucose) / temperature • Thrombosis (coronary / PE) / tension pneumothorax / toxins / tamponade 📋 Outcome: • ROSC: [Y/N] at [time] • If ROSC: SpO₂ 94–98%; PaCO₂ normal; SBP >100; 12-lead ECG; ABCDE; cause; temperature control 📌 Plan: • Critical care / cardiology: [ ] • Trust arrest form completed: [Y/N] • Family updated: [Y/N] 👤 [Your Name], [Role] IMC: _______