Quality Standards: Acute care equipment and drug lists

Authors
Resuscitation Council UK
originally published November 2013. Last updated May 2020.
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Healthcare organisations have an obligation to provide a high-quality resuscitation service, and to ensure that staff are trained and updated regularly to a level of proficiency appropriate to each individual’s expected role.

As part of the quality standards for cardiopulmonary resuscitation practice and training this document provides lists of the minimum equipment and drugs required for cardiopulmonary resuscitation. These lists are categorised according to the clinical setting.

The equipment and drug lists on this page are in reference to the Acute Care Quality Standards.

The core standards for the provision of cardiopulmonary resuscitation across all healthcare settings are described in the Introduction and Overview to Quality Standards

Drug tables for cardiac arrest are highlighted in the text with the symbol ! 

  1. All clinical service providers must ensure that their staff have immediate access to appropriate resuscitation equipment and drugs to facilitate rapid resuscitation of the patient in cardiorespiratory arrest. The standard defibrillator sign should be used in order to reduce delay in locating a defibrillator in an emergency. The sign can be downloaded here.
  2. All settings must have a means of calling for help (e.g. landline telephone [internal or external], mobile telephone with reliable signal, or alarm bell).
  3. Standardisation of the equipment used for cardiopulmonary resuscitation (including defibrillators and emergency suction equipment), and the layout of equipment and drugs throughout an organisation is recommended.
  4. It is recognised that planning for every eventuality is complex; therefore, organisations must undertake a risk assessment to determine what resources are required given their local circumstances. Risk factors to consider include patient group (e.g. adults, children), incidence of cardiac arrest, training of staff, and access to expert help.
    • a. For example, in secondary or tertiary care specific locations may need special provisions (e.g. for failed intubation, tracheostomy care, cardiac arrest in pregnancy etc).
    • b. Some settings need a wide range of equipment immediately available (e.g. resuscitation room in emergency department). Suggested options include having basic equipment (and possibly drugs) available immediately (on a resuscitation trolley), and further equipment and drugs arriving with a resuscitation team (in a ‘grab-bag’), or in some settings as part of an ambulance response.
    • c. Staff should be trained to use the available equipment according to their expected roles.
  5. Depending on the organisation, this risk assessment must be overseen by a Resuscitation Committee or a designated resuscitation lead. Expert advice should also be sought locally from those commonly involved in resuscitation (e.g. resuscitation officers, emergency physicians, cardiac care unit staff, intensivists, anaesthetists, prehospital care physicians).
  6. Resuscitation equipment should be single-patient-use and latex-free, whenever possible and appropriate. Where non-disposable equipment is used, a clear policy for decontamination after each use must be available and must be followed.
  7. Personal protective equipment (e.g. gloves, aprons, eye protection) and sharps boxes must be available, based on a local risk assessment and local polices.
  8. A reliable system of equipment checks and replacement must be in place to ensure that equipment and drugs are always available for use in a cardiac arrest. The frequency of checks should be determined locally.
  9. It is recommended that equipment and drugs are presented in a clear and logical manner to enable easier use during an emergency.
  10. The manufacturer’s instructions must be followed regarding use, storage, servicing and expiry of equipment and drugs.
  11. Further equipment and drugs may be needed to manage other types of emergencies that are likely to be encountered in a particular setting; this may include:
    • monitoring equipment (e.g. blood pressure, pulse oximetry, 3-lead electrocardiogram [ECG], temperature, waveform capnography),
    • 12-lead ECG recorder,
    • difficult airway equipment (e.g. scalpel and bougie for cricothyroidotomy),
    • near-patient tests (e.g. blood glucose, blood gas analysis).
  12. A formal procurement process that includes trialling of equipment before purchase is recommended. Trialling of resuscitation equipment can take place in actual care settings or in simulated clinical scenarios.
  13. The precise availability of equipment and drugs should be determined locally. The equipment lists include a suggestion on the immediacy with which equipment and drugs should be available:
    • a. Immediate - available for use within the first minutes of cardiorespiratory arrest (i.e. at the start of resuscitation).
    • b. Accessible - available for prompt use when the need is determined by resuscitation team.
  14. These lists are not exhaustive. Local experts should be consulted to ensure that the appropriate equipment and drugs are available when they are needed, to enable provision of high-quality attempted resuscitation.

The equipment and drug lists in this chapter are for adult acute hospital care. 

Drug tables for cardiac arrest are highlighted in the text with the symbol ! 

Acute Hospital Care - Adult

Airway and breathing

Item Suggested Availability Comments
Pocket mask with oxygen port Immediate According to local policy 
Oxygen mask with reservoir  Immediate  
Self-inflating bag with reservoir  Immediate  
Clear face masks, sizes 3, 4, 5  Immediate  
Oropharyngeal airways, sizes 2, 3, 4  Immediate  
Nasopharyngeal airways, sizes 6, 7 (and lubrication)  Immediate  
Portable suction (battery or manual) with Yankauer sucker and soft suction catheters Immediate Airway suction equipment. NPSA Signal. Reference number 1309. February 2011
Supraglottic airway device with syringes, lubrication and ties/tapes/scissors as appropriate  Immediate/Accessible  Choice of device (e.g. laryngeal mask airway, i-gel®, laryngeal tube) and size will depend on local policy and staff training
Oxygen cylinder (with key where necessary)  Immediate  
Oxygen tubing Immediate  
Magill forceps Immediate  
Stethoscope Immediate  
Tracheal tubes, cuffed, sizes 6, 7, 8  Immediate/Accessible  This will depend on local policy and staff training. For example, there is not consensus on the role of a ‘stylet’
Tracheal tube introducer (stylet)  Immediate/Accessible  This will depend on local policy and staff training. For example, there is not consensus on the role of a ‘stylet’

Laryngoscope handles (x 2) and blades (size 3 and 4)

Spare batteries for laryngoscope and spare bulbs (if applicable) 

Immediate/Accessible  This will depend on local policy and staff training. For example, there is not consensus on the role of a ‘stylet’
Syringes, lubrication and ties/tapes/scissors for tracheal tube  Immediate/Accessible 

This will depend on local policy and staff training. For example, there is not consensus on the role of a ‘stylet’ 

Waveform capnograph - with appropriate tubing and connector  Immediate/Accessible 

For use with supraglottic airways or tracheal tube. NAP4 - 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society, March 2011. 

Standards of monitoring during anaesthesia and recovery. Association of Anaesthetist of Great Britain and Ireland, 2011.

EBA Recommendation for the use of Capnography. European Board of Anaesthesiology, 2011.

Acute Hospital Care - Adult

Circulation

Item Suggested availability Comments
Defibrillator
Manual and/or automated external defibrillator
Pacing function if needed 
Immediate Type of defibrillator, and locations determined by a local risk assessment. Available to enable shock within 3 minutes of collapse. Pacing function is recommended for cardiac units, cardiac catheter laboratories, emergency departments, intensive care units and operating theatres. It may also be appropriate for other settings, and this should be determined locally
Adhesive defibrillator pads  Immediate Spare set of pads also recommended. Pads should be suitable for external pacing if needed
Razor Immediate  
ECG electrodes Immediate  
Intravenous cannulae (selection of sizes) and 2% chlorhexidine/alcohol wipes, tourniquets and cannula dressings  Immediate/Accessible  
Adhesive tape Immediate/Accessible  
Intravenous infusion set Immediate/Accessible  
0.9% sodium chloride (1000 ml)  Immediate/Accessible Amount depends on availability of further supplies 
Selection of needles and syringes  Immediate/Accessible  
Intra-osseous access device  Accessible   
Central venous access - Seldinger kit, full barrier precautions (hat, mask, sterile gloves, gown) and skin preparation (2% chlorhexidine / alcohol)  Accessible  Placed with ultrasound guidance, where possible 
Ultrasound / echocardiography  Accessible  To identify and treat reversible causes of cardiorespiratory arrest 

Acute Hospital Care - Adult

Other items

Item Suggested availability Comments
Clock/timer Accessible  
Gloves, aprons, eye protection Immediate Further personal protective equipment may be required according to local policy
Nasogastric tube Accessible  
Sharps container and clinical waste bag Immediate Sharps container must be immediately available wherever sharps used
Large scissors Accessible  
2% chlorhexidine / alcohol wipes Accessible  
Blood sample tubes Accessible  
IV extension set Accessible Types of connectors, ports, and caps to be determined locally 
Pressure bags for infusion Accessible  
Blood gas syringe Accessible  
Blood glucose analyser with appropriate strips  Immediate/Accessible According to local policy 
Drug labels Accessible Guidance on colour coding for syringe labels 
Manual handling equipment  Accessible According to setting. 
See Guidance for safer handling during resuscitation in healthcare settings
Cardiorespiratory arrest record forms for patient records, audit forms and DNACPR forms  Accessible  
Access to algorithms, emergency drug doses  Accessible  

Acute Hospital Care - Adult

CARDIAC ARREST DRUGS - FIRST LINE for intravenous use !

Item Suggested availability Comments
Adrenaline 1mg (= 10 ml 1:10,000) as a prefilled syringe x 3  Immediate Number of syringes depends on access to further syringes. 1mg needed for each 4-5 min of CPR 
Amiodarone 300mg as a prefilled syringe x 1  Accessible First dose required after 3 defibrillation attempts 

Acute Hospital Care - Adult

CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use ! 

Item Suggested availability Comments
Adenosine 6 mg x 5 Accessible   
Atropine - 1mg x 3  Accessible   
Adrenaline 1mg (= 10 ml 1:10,000) prefilled syringe  Accessible  Further syringes should be accessible for prolonged resuscitation attempts 
Amiodarone 300mg x 1  Accessible  If decision is made to give further doses of amiodarone 
Calcium chloride 10 ml 10% x 1  Accessible Calcium gluconate can be used as an alternative. Note: 
10 ml 10% Calcium chloride = 
6.8 mmol Ca2+
10 ml 10% Calcium gluconate = 2.26 mmol Ca2+
Chlorphenamine 10 mg x 2  Accessible Second-line treatment for anaphylaxis, can also be given intramuscularly 
Hydrocortisone 100 mg x 2  Accessible Second-line treatment for anaphylaxis, can also be given intramuscularly  
Glucose for intravenous use  Immediate/Accessible  Volume and concentration according to local policy 
20% lipid emulsion 500 ml  Accessible  For use in areas where large doses of local anaesthetic are used for regional blocks, according to Association of Anaesthetists Guidelines. 
Lidocaine 100 mg x 1  Accessible Inclusion to be determined locally 
Magnesium sulphate (2 g = 8 mmol) x 1  Accessible  
Midazolam 5 mg in 5 ml x 1  Accessible NPSA Alert 
Naloxone 400 microgram x 5  Accessible  
Potassium chloride  Accessible

Formulation to be determined locally.

Potassium chloride concentrate solutions. Patient safety alert. The National Patient Safety Agency. July 2002. 

Sodium bicarbonate 8.4% or 1.26%  Accessible Volume and concentration according to local policy 

Acute Hospital Care - Adult

Other drugs

Item Suggested availability Comments
Adrenaline 1mg (1 ml 1:1000)  Immediate First-line treatment for anaphylaxis - 0.5 mg intramuscular injection in adults
Aspirin 300 mg and other antithrombotic agents  Accessible For acute coronary syndrome according to local policy 
Furosemide 50 mg IV x 2  Accessible  
Flumazenil 0.5 mg IV x 2  Accessible  
Glucagon 1 mg IV x 1 Accessible  
GTN spray Accessible  
Ipratropium bromide 500 microgram nebules x 2 (and nebuliser device)  Accessible  
Salbutamol 5mg nebules x 2 (and nebuliser device) and IV preparation for infusion  Accessible  
0.9% sodium chloride or Hartmann’s solution 1000 ml x 2 cooled to 4°C  Accessible For induction of therapeutic hypothermia as part of post-cardiorespiratory arrest care 

Notes

  1. Portable monitoring and other equipment for patient transfer should be readily available.
  2. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be available readily, according to local critical care policies.
  3. Keeping resuscitation drugs locked away - this problem was addressed in detail in 2005 by the Royal Pharmaceutical Society of Great Britain in a revision of the Duthie Report (1988) ‘The Safe and Secure Handling of Medicines’. Resuscitation Council UK responded with a statement, along with an accompanying letter written to the CQC explaining the position. 

Supporting information

  1. Association of Anaesthetists of Great Britain and Ireland (AAGBI) Safety Guideline - Interhospital Transfer. 2009. http://www.aagbi.org
  2. Intensive Care Society. Guidelines for the Transport of the Critically Ill Adult (3rd Edition 2011). http://www.ics.ac.uk
  3. The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus https://www.diabetes.org.uk/Documents/About%20Us/Our%20views/Care%20recs/JBDS%20hypoglycaemia%20position%20(2013).pdf

The equipment and drug lists in this chapter are for paediatric acute hospital care. 

Drug tables for cardiac arrest are highlighted in the text with the symbol ! 

 

Acute Hospital Care - Paediatric

Airway and breathing

Item Suggested availability Comments
Pocket mask with oxygen port - paediatric and adult  Immediate According to local policy
Oxygen mask with reservoir - paediatric and adult  Immediate  
Self-inflating bag with reservoir - paediatric and adult  Immediate  
Clear face masks, size 00, 0, 1, 2, 3, 4, 5  Immediate  
Oropharyngeal airways, sizes 00, 0, 1, 2, 3, 4  Immediate  
Nasopharyngeal airways, sizes 4.0, 4.5, 5.0, 5.5, 6.0, 7.0 (and lubrication)  Immediate Uncuffed tracheal tubes of appropriate length may be used as an alternative according to local policy 
Portable suction (battery or manual) with Yankauer sucker (paediatric and adult) and soft suction catheters, sizes 5, 6, 8, 10, 12, 14  Immediate  
Oxygen cylinder (with key if necessary)  Immediate  
Oxygen tubing Immediate  
Magill forceps (adult and paediatric sizes)  Immediate  
Stethoscope Immediate  
Supraglottic airway device with syringes, lubrication and ties/tapes/scissors as appropriate  Accessible Choice of device and size will depend on local policy and staff training 
Tracheal tubes, uncuffed sizes 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6  Accessible Cuffed paediatric tubes according to local policy 
Tracheal tubes, cuffed sizes 6, 7, 8,  Accessible   
Croup tube (uncuffed, longer than standard tracheal tube), sizes 2, 2.5, 3, 3.5  Accessible Alternative devices may be substituted according to local policy (e.g. Cole's® tubes) 
Tracheal tube introducer (stylet) small and medium  Accessible  
Intubating bougie - 5 Ch & 10 Ch  Accessible  
Laryngoscope handles (x 2) and blades (sizes -straight 0, 1, curved 2, 3, 4)
Spare batteries for laryngoscope and spare bulbs (if applicable) 
Accessible  
Syringes, lubrication and ties/tapes (e.g. Elastoplast® / Hypofix® /ribbon gauze/tape) and scissors  Accessible  
Waveform capnograph - with appropriate tubing and connector (battery-operated)  Accessible NAP4 - 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society, March 2011 

Acute Hospital Care - Paediatric

Circulation

Item Suggested availability Comments
Defibrillator
- Manual and/or automated external defibrillator (AED) 
Immediate

Type of defibrillator and locations decided by a local risk assessment. AEDs are not intended for use in infants (less than 12 months old) and this should be considered at risk assessment

Availability of pacing function according to local policy

Adhesive defibrillator pads - paediatric and adult sizes  Immediate Spare set of pads also recommended. Pads should be suitable for external pacing if needed
ECG electrodes (paediatric & adult sizes) Accessible  
Intravenous cannulae (sizes 14, 16, 18, 20, 22, 24G) and 2% chlorhexidine / alcohol wipes, tourniquets and dressings  Immediate  
Adhesive tape Immediate  
Intravenous infusion sets (with and without incorporated burette)  Accessible  
IV extension set with 3-way taps and bungs  Accessible  
0.9% sodium chloride¹  Accessible Amount depends on access to further fluids 
10% Dextrose¹  Accessible  
Selection of needles and syringes  Immediate  
Intra-osseous access device with needles suitable for neonates, children and adults  Immediate  
Colloid solution for IV infusion¹  Accessible According to local policy 
Central venous access - Seldinger kit, full barrier precautions (hat, mask, sterile gloves, gown) and skin preparation (2% chlorhexidine / alcohol)  Immediate Sizes and type according to local policy. Placed with ultrasound guidance, where possible 
Ultrasound / echocardiography  Immediate To identify and treat reversible causes of cardiorespiratory arrest 

Acute Hospital Care - Paediatric

Other items

Item Suggested availability Comments
Clock / timer Accessible  
Gloves, aprons, eye protection Immediate  
Urinary catheter, sizes 6-14 Accessible  
Nasogastric tube, sizes 6-14 Accessible  
Sharps container and clinical waste bag Immediate Sharps container must be immediately available wherever sharps are used
Large scissors Accessible  
2% chlorhexidine / alcohol wipes Accessible  
Blood sample tubes Accessible  
Pressure bags for infusion Accessible  
Blood gas syringe Accessible  
Blood glucose monitor with appropriate strips Immediate/Accessible  
Drug labels Accessible Guidance on syringe labels
Manual handling equipment Accessible According to setting. See Guidance for safer handling during resuscitation in healthcare settings
Cardiorespiratory arrest record form for patient records and audit forms. DNACPR forms appropriate for children.  Accessible  
Access to algorithms, emergency drug doses, paediatric drug dose calculators (e.g. Broselow tape)  Immediate According to local policy

Acute Hospital Care - Paediatric

CARDIAC ARREST DRUGS - FIRST LINE for intravenous use ! 

Item Suggested availability Comments
Adrenaline 1mg (= 10 ml 1:10,000) prefilled syringe(s)¹  Immediate Number of syringes depends on ease of access to further syringes if needed 
Amiodarone 300mg prefilled syringe(s)¹  Accessible  

Acute Hospital Care - Paediatric

CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use ! 

Item Suggested availability Comments
Adenosine 6 mg¹  Accessible  
Atropine 1mg¹  Accessible ALERT: Atropine is available in various concentrations 
Adrenaline 1mg (= 10 ml 1:10,000)  Accessible  
Amiodarone 300mg¹  Accessible  
Calcium chloride 10 ml 10%¹ Accessible Calcium gluconate may be used as an alternative. Note:
10 ml 10% Calcium chloride = 6.8 mmol Ca2+
10 ml 10% Calcium gluconate = 2.26 mmol Ca2+
Chlorphenamine 10 mg¹  Accessible Second-line treatment for anaphylaxis, can also give intramuscular 
Diazepam and/or Lorazepam  Accessible For treatment of status epilepticus. Agent, dose and route of administration according to local policy 
Hydrocortisone 100 mg¹  Accessible Second-line treatment for anaphylaxis, can also be given intramuscularly
Glucose¹ Accessible Concentration according to local policy 
20% Lipid emulsion¹  Accessible For local anaesthetic toxicity 
Lidocaine 100 mg¹  Accessible  
Magnesium sulfate (2 g = 8 mmol)¹  Accessible  
Midazolam 5 mg in 5 ml¹  Accessible NPSA Alert
Morphine¹  Accessible According to local policy 
Naloxone 400 microgram¹  Accessible  
Potassium chloride¹  Accessible Potassium chloride concentrate solutions. Patient safety alert.  The National Patient Safety Agency. July 2002.
Sodium bicarbonate 8.4% or 1.26%¹  Accessible Concentration and preparation according to local policy

Acute Hospital Care - Paediatric

OTHER EMERGENCY DRUGS

Item Suggested availability Comments
Adrenaline 1mg (1 ml 1:1000)¹  Immediate First-line treatment for anaphylaxis.
Can be part of an ‘anaphylaxis kit’ so that it is not mixed / confused with cardiorespiratory arrest drugs 
Furosemide 50 mg IV¹  Accessible  
Flumazenil 0.5 mg IV¹  Accessible  
Glucagon 1 mg IV¹  Accessible  
Ipratropium bromide 500 microgram nebules (and nebuliser device)¹  Accessible  
Salbutamol 5mg nebules (and nebuliser device)¹  Accessible  
Salbutamol 1mg/ml for IV infusion¹  Accessible  
  1. The volume and/or quantities of the listed fluids and drugs stored and their location should be determined by local policy. This should ensure that there is sufficient availability to manage a paediatric resuscitation according to Resuscitation Council UK resuscitation guidelines without undue delay.
  2. Portable monitoring and other equipment for patient transfer should be readily available.
  3. Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be readily available according to local critical care policies.
  4. All interventions (e.g. drug therapy, practical procedures, discussions with other staff or relatives) should be documented with date and time and signed by an identifiable member of staff.
  5. Keeping resuscitation drugs locked away - this problem was addressed in detail in 2005 by the Royal Pharmaceutical Society of Great Britain in a revision of the Duthie Report (1988) ‘The Safe and Secure Handling of Medicines’. Resuscitation Council UK responded with a statement, along with an accompanying letter written to the CQC explaining the position.