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ALS Adrenaline Timing — FRCA Final MCQ

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ModerateAnaesthetic Equipment & SafetyALS Adrenaline TimingFRCA Final

A 55-year-old woman develops cardiac arrest with ventricular fibrillation during hip replacement under spinal anaesthesia. CPR is commenced, and ventricular fibrillation persists at each rhythm check despite defibrillation. According to the standard UK adult advanced life support algorithm, when should the first dose of adrenaline be administered?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — During CPR immediately after the third shock

The correct answer is B. For persistent VF or pulseless VT, defibrillation and high-quality CPR take priority. The first dose of adrenaline is administered during the CPR cycle immediately following the third shock, without interrupting chest compressions. Further adrenaline is given every 3–5 minutes. Adrenaline is therefore not routinely given after the first, second or fourth shock. Immediate adrenaline applies to an initially non-shockable rhythm such as PEA or asystole; a change to a non-shockable rhythm is not required before giving it in persistent VF. Although smaller, titrated adrenaline doses may be considered in selected early perioperative low-flow states, that does not alter the standard ALS timing tested here.

Reference: Royal College of Anaesthetists. NAP7 Chapter 25: Advanced life support for perioperative cardiac arrest—triggers for chest compressions, adrenaline dosing and timing in adults. 2023. https://rcoa.ac.uk/sites/default/files/documents/2023-11/NAP7_Chapter%2025_FINAL.pdf