Like the treatment of the shockable rhythms, the management of asystole and PEA centers around cycles of high-quality CPR. The best management of these cardiac arrest arrhythmias consists of effective chest compressions and ventilations, as well as the diagnosis of any underlying and reversible cause of cardiac arrest. For nonshockable rhythms, it is important to administer epinephrine as soon as possible, followed by continued high-quality CPR.

For managing these rhythms:

Responders check the cardiac rhythm and repeat CPR for 2 minutes after epinephrine administration. Interruptions to compressions should be limited.

• If asystole persists, CPR is repeated
• If an organized rhythm is present, one responder checks the pulse, taking between 5 and 10 seconds to do so.
• If unable to feel the pulse, responders repeat CPR for 2 minutes (this can be stopped early if ETCO2 rises abruptly > 40 mm Hg)
• Epinephrine is given every 3–5 minutes while CPR continues.
• At the next rhythm check, if a pulse is present, the team proceeds to post-arrest care.
• If there is a shockable rhythm, CPR is repeated while the defibrillator prepares to give the shock. They switch back to the algorithm for shockable rhythms, giving CPR, shocks, and epinephrine.
• During this process, responders should switch roles at 2-minute intervals to limit fatigue and ensure the delivery of high-quality CPR. 

The perfusion pressure of the coronaries (CPP) is calculated by subtracting the diastolic pressure during right atrial relaxation from diastolic pressure of aortic relaxation. CPP is associated with blood flow to the cardiac muscle and the return of spontaneous circulation (ROSC). Studies have shown that CPP should be at least 15 mm Hg to ensure high-quality CPR.