August 2026: Action-Based Approach to Cardiac Arrest

The traditional "H's and T's" mnemonic for managing cardiac arrest is an outdated, cognitively taxing, and non-standardized tool that should be replaced by an action-based paradigm. Dr. Duncan Grossman, education faculty at Harlem Hospital Center, argues that the mnemonic fails because it lacks a universal definition and includes non-reversible causes like acidosis. Instead, clinicians should adopt a four-step framework: assigning specific roles, performing targeted bedside ultrasound for pneumothorax and tamponade, obtaining a point-of-care blood gas, and considering lytics and ECMO. This shift moves the focus from active recall during high-stress resuscitations to a reactive process where critical information is pushed to the physician. By standardizing these four steps, medical teams can efficiently address reversible causes of cardiac arrest regardless of their specific practice setting or available resources.