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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 !
- 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.
- 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).
- 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.
- 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 the 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.
- 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 practitioners/resuscitation officers, emergency physicians, cardiac care unit staff, intensivists, anaesthetists, pre-hospital care physicians etc).
- Resuscitation equipment should be single-patient-use and latex-free. Where non-disposable equipment is used, a clear policy for decontamination after each use must be available and must be followed.
- Personal protective equipment (e.g. gloves, aprons, face mask, eye protection) and sharps boxes must be available based on a local risk assessment and national/local polices.
- 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.
- It is recommended that equipment and drugs are presented in a clear and logical manner to enable easier use during an emergency.
- The manufacturer’s instructions must be followed regarding use, storage, servicing and expiry of equipment and drugs.
- 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).
- 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.
- 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 the resuscitation/emergency response team.
- 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 the 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/accessible | According to local policy |
| Oxygen mask with reservoir (non-rebreather mask) | Immediate | |
| Self-inflating bag with reservoir (bag-valve-mask) | 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. |
| Tracheal tube introducer (stylet) | Immediate/Accessible | This will depend on local policy and staff training. For example, there is no 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. |
| Syringes, lubrication and ties/tapes/scissors for tracheal tube, HME filter | Immediate/Accessible |
This will depend on local policy and staff training. |
| Waveform capnograph - with appropriate tubing and connector | Immediate |
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, 2021. 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 | |
| Intraosseous access device | Accessible | |
| Central venous access - Seldinger kit, full barrier precautions (hat, mask, sterile gloves, gown) and skin preparation (2% chlorhexidine / 70% 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, face masks, eye protection | Immediate | Further personal protective equipment may be required according to national/local policy |
| Nasogastric tube | Accessible | |
| Sharps container and clinical waste bag | Immediate | Sharps container must be immediately available wherever sharps used |
| Large scissors (e.g. heavy duty scissors) | Accessible | |
| 2% chlorhexidine / 70% 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, DNACPR/ReSPECT 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 3-5 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+ |
| 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) x2 | 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 5 mg 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 temperature management as part of post-cardiorespiratory arrest care |
Notes
- Portable monitoring and other equipment for patient transfer should be readily available.
- Staff must be aware of where to locate additional cardiac arrest drugs (if needed) as per local policy.
- Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be available readily, according to local critical care policies.
- 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
- Association of Anaesthetists of Great Britain and Ireland (AAGBI) Safety Guideline - Interhospital Transfer. 2009. http://www.aagbi.org
- The faculty of Intensive Care Medicine and the Intensive Care Society. Guidelines on: The Transfer of the Critically Ill Adult (2019). http://www.ics.ac.uk/resource/transfer-critically-adult.html
- 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 (non-rebreather mask) | Immediate | |
| Self-inflating bag with reservoir - paediatric and adult (bag-valve-mask) | 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 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6 | Accessible | Cuffed paediatric tubes according to local policy |
| Tracheal tubes, cuffed sizes 3, 3.5, 4, 4.5, 5, 5.5, 6, 7, 8, | Accessible | |
| Tracheal tube introducer (stylet) small and medium | Accessible | |
| Intubating bougie - 5 Ch & 10 Ch | Accessible | |
| Laryngoscope handles (x 2) and blades - straight (Miller) 0, 1, 2, 3. Curved (Macintosh) 1, 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) | Immediate | 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, 24 G) and 2% chlorhexidine / 70% 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 chloride | Accessible | Amount depends on access to further fluids |
| 10% Dextrose | Accessible | |
| Selection of needles and syringes | Immediate | |
| Intraosseous 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 / 70% 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 / 70% 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/ReSPECT 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) | Accessible |
Acute Hospital Care - Paediatric
CARDIAC ARREST & PERI-ARREST DRUGS for intravenous use!
| Item | Suggested availability | Comments |
|---|---|---|
| Adenosine 6 mg | Accessible | |
| Atropine 1 mg | Accessible | ALERT: Atropine is available in various concentrations |
| Adrenaline 1mg (= 10 mL 1:10,000) | Accessible | |
| Amiodarone 300 mg¹ | Accessible | |
| Calcium chloride 10 mL 10% | 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+ |
| Midazolam and/or Lorazepam | Accessible | For treatment of status epilepticus. Agent, dose and route of administration according to local policy |
| Glucose | Accessible | Concentration according to local policy |
| 20% Lipid emulsion | Accessible | For local anaesthetic toxicity |
| Lidocaine 100 mg | Accessible | |
| Magnesium sulfate (2 g = 8 mmol) | Accessible | |
| Midazolam 5 mg in 5 ml | Accessible | NPSA Alert |
| Morphine | Accessible | According to local policy |
| Naloxone 400 microgram | Accessible | |
| Potassium chloride | Accessible | Potassium chloride concentrate solutions. Patient safety alert. The National Patient Safety Agency. July 2002. |
| Sodium bicarbonate 8.4% or 1.26% | 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) | 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 IV | Accessible | |
| Flumazenil 0.5 mg IV | Accessible | |
| Glucagon 1 mg IV | Accessible | |
| Ipratropium bromide 500 microgram nebules (and nebuliser device) | Accessible | |
| Salbutamol 5mg nebules (and nebuliser device) | Accessible | |
| Salbutamol 1mg/mL for IV infusion | Accessible |
- 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.
- Portable monitoring and other equipment for patient transfer should be readily available.
- Staff must be aware of where to locate additional cardiac arrest drugs (if needed) as per local policy
- Further drugs for post-cardiac-arrest care (e.g. inotropes, vasopressors, anaesthetic agents, antibiotics) should be readily available according to local critical care policies.
- 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.
- Personal protective equipment (e.g. gloves, aprons, face mask, eye protection) and sharp boxes must be available based on local risk assessment and national/local policies.
- 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.