Cardiovascular Critical Care II

Medication

Primary Mechanism

of Action in Cardiac

Arrest

Dosage, Route,

Frequency

Clinical Benefits

Epinephrine

(N Engl J Med

1992;327:1045-50;

Circulation 1984;69:

1979;7:293-6)

α-Adrenergic agonist

effects leading to

vasoconstriction

1 mg IV/IO q3–5 min

2–2.5 mg ET q3–5

min (diluted with

either 5–10 mL of

0.9% sodium chloride

or sterile water)

Increases coronary and cerebral

perfusion pressure during CPR

Increases ROSC

Increases survival to hospital

admission and discharge in OHCA

Amiodarone

(N Engl J Med

2002;346:884-90;

N Engl J Med

1999;341:871-8;

N Engl J Med

2016;374:1711-22)

Na+/K+/Ca2+ channel

and β-receptor

antagonist

(Class III

antiarrhythmic)

First dose: 300 mg

IV/IO x 1

Second dose: 150 mg

IV/IO x 1

Max: 2.2 g/day

Conflicting data on clinical outcomes

compared with lidocaine or placebo for

OHCA

Lidocaine

(Resuscitation

1997;33:199-205;

N Engl J Med

2016;374:1711-22)

Na+ channel

antagonist

(Class IB

antiarrhythmic)

First dose: 1–1.5 mg/

kg IV/IO x 1

Subsequent dosing:

0.5–0.75 mg/kg q5–10

min

Max 3-mg/kg

cumulative dose

Conflicting data on clinical outcomes

for OHCA; no improvement in overall

or survival to hospital discharge

Insufficient evidence to recommend

for refractory VF/pVT unless

amiodarone unavailable

Magnesium

(Clin Cardiol

1993;16:768-74; New

Trends Arrhythmias

1991;7:437-42;

Circulation

1988;77:392-7)

Stops EAD in

torsades de pointes

by inhibiting Ca2+

channel influx

1–2 g diluted in 10

mL of 5% dextrose or

sterile water IV/IO × 1

Can aid in stopping torsades de pointes

in patients with prolonged QT interval

EAD = early afterdepolarization; ET = endotracheal; IO = intraosseously; IV = intravenously; pVT = pulseless ventricular tachycardia; q = every.

Management of PEA/asystole

CPR and treatment of reversible causes are vital to treatment of PEA/asystole.

ii.

Medication therapy

4 minutes after non-shockable IHCA (BMJ 2014;348:1-9). A randomized, double-

blind, placebo-controlled trial found that use of epinephrine in OHCA (around 80%

non-shockable rhythms) was associated with greater 30-day survival, but there was

no difference in neurologically favorable outcomes because of the severe neurologic

impairment of survivors (N Engl J Med 2018;379:711-21).