In a non-shockable cardiac arrest (asystole or PEA), what is the recommended sequence after initiating CPR?

• A. Defibrillate first
• B. Stop CPR to assess ROSC
• C. Continue CPR for 2 minutes, obtain vascular access, administer epinephrine 1:10,000 1 mg IV/IO
• D. Administer epinephrine before CPR

Answer: (C)

In non-shockable cardiac arrest, the priority is continuous, high-quality CPR to maintain perfusion, since defibrillation won’t restore rhythm in asystole or PEA. The best sequence after starting compressions is to continue CPR for about 2 minutes, obtain vascular access during that time, and administer epinephrine 1 mg IV/IO, with subsequent doses every 3–5 minutes while CPR continues. Epinephrine helps raise aortic diastolic pressure and improve blood flow to the heart and brain during chest compressions. It should be given during CPR, not before starting compressions, and you should keep delivering cycles of CPR with brief rhythm checks rather than pausing long or stopping to check ROSC prematurely.