If the patient becomes apneic (not breathing) and pulseless, but the rhythm remains the same (assuming it is still ventricular fibrillation), the highest priority is:

• Resume high-quality CPR immediately.

This includes:

1. High-quality chest compressions at a rate of 100-120 per minute and a depth of at least 2 inches (5 cm), allowing full chest recoil between compressions.
2. Minimizing interruptions in chest compressions.
3. Providing ventilations at a ratio of 30 compressions to 2 breaths if an advanced airway is not in place, or 1 breath every 6 seconds (10 breaths per minute) if an advanced airway is in place.

Following this, other priorities include:

1. Defibrillation: If the rhythm remains ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), deliver a defibrillation shock as soon as possible.
2. Medication administration: Continue with the administration of epinephrine 1 mg IV/IO every 3-5 minutes.
3. Consider antiarrhythmic drugs: If VF/VT persists after multiple defibrillation attempts, consider administering amiodarone 300 mg IV/IO bolus (first dose), followed by a second dose of 150 mg if needed.