Pulseless V-Tach & V-Fib Algorithm

AHA 2015 ACLS Algorithm for the treatment of pulseless ventricular tachycardia (VT) and ventricular fibrillation (VF)

Pulseless Ventricular Tachycardia and Ventricual Fibrillation are two "shockable" dysrhythmia that can be present in a patient/victim during a cardiac arrest.  These rhythms originate within the ventricles and do not create a palpable pulse.

Treatment of these dysrhythmias are based upon stopping these rhythms in the hope that a regular or perfusing rhythm will replace it.

Pulseless Ventricular tachycardia (V-tach or VT) is a type of tachycardia, or a rapid heartbeat, that starts in the ventricles. Ventricular tachycardia can be classified based on its morphology: Monomorphic presents with all the ECG complexes match each other and Polymorphic has beat-to-beat variations in morphology. 

Ventricular fibrillation (V-fib or VF) is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. Ventricular fibrillation has been shown to be the most commonly identified arrhythmia in cardiac arrest patients.

Perform initial assessment

Perform High Quality CPR and attach ECG

If VT/VF present

Defibrillate with 120-200 Joules on a biphasic defibrillator
(Immediately resume High Quality CPR for 2 minutes and initiate IV/IO
Administer Epinephrine 1mg IV/IO q/3-5 minutes once IV/IO initiated.
Consider advanced airway (ETT, Supraglottic Airway)

After 2 minutes VF/VT?

Defibrillate & immediately resume High Quality CPR for 2 minutes
Administer Amiodarone IV 300 mg (May repeat 150 mg in 5 minutes)
Consider Reversible Causes (H’s & T’s)

Continue 2 min cycles and provide subsequent CPR, Defibrillation and Rx until:

The monitor and assessment show Asystole or PEA, move to Asystole/ PEA algorithm
If the patient attains Return of Spontaneous Circulation (ROSC), provide Post Cardiac Arrest Care


  • Providing high quality CPR with minimal interruptions and early defibrillation are key to patient survival.
  • Always consider and correct reversible causes in all cardiac arrest patients.
  • Administer Magnesium Sulfate 1-2 g IV (over 2 min) for suspected hypomagnesemia or torsades de pointes (polymorphic VT)