In certain cardiac arrest situations, modifications to current cardiac resuscitation algorithms may improve patient outcome. These situations are often rare, but when they occur they house the potential for severe time and resource use, and in some cases specialized skill sets. The decision to apply these modifications to standard care for the cardiac arrest patient may be obvious in some cases or may be applied due to suspicion from the presenting medical history, history of present illness, or physical examination. However, with rare exception, general care of any cardiac arrest patient should include continuous high-quality chest compressions and appropriate airway and ventillatory management.