Compressions should be started at the apex of the heart and massage towards the base. Once basic life support is in progress and extra help arrives, management of the problem causing the arrest can follow. These measures should increase the effectiveness of resuscitation. Using the ECG, appropriate drug treatment can be used. If there is no ECG, assume cardiac asystole has occurred.
Treatments follow until normal rhythm obtained.
A peripheral vein is not as good, but fluids can be administered by this route and it is better than intracardiac injection. Atropine, epinephrine and lidocaine can be administered by this route using a catheter placed down the endotracheal tube to the bifurcation of the trachea. The drug is flushed through with saline and the lungs are then ventilated. Uptake of the drug by the blood is rapid and the effects can be dramatic. Immediately after restoring circulation, neurological function must be supported.