ACLS review: Pulseless VF/VT Part 6

Drug Therapy: Antiarrhythmics

Amiodarone

Lidocaine

Note

When VF/pulseless VT persists after 2 to 3 shocks plus CPR and administration of a vasopressor, consider administering an antiarrhythmic such as Amiodarone.  If Amiodarone is unavailable, Lidocaine may be considered. Consider magnesium for torsades de pointes associated with a long QT interval. You should administer the drug during CPR, as soon as possible after rhythm analysis

Amiodarone

·         First antiarrhythmic

·         Initial dose 300mg IV/IO diluted in 20cc of NS or D5W

·         May repeat in 5 minutes with 150mg IV/IO diluted in 20cc of NS or D5W      

·         Max dose 2.2g/24h

After 2 minutes of CPR defibrillate at 200J or higher and analyze the rhythm

Note:

Amiodarone is the first-line antiarrhythmic agent given during cardiac arrest because it has been clinically demonstrated to improve the rate of ROSC and hospital admission in adults with refractory VF/pulseless VT. Amiodarone may be considered when VF/VT is unresponsive to CPR, defibrillation, and vasopressor therapy (Class IIb, LOE A).

 Lidocaine

·         Initial dose 1-1.5mg/kg IV/IO push

·         May repeat in 5 minutes at 0.5-0.75mg/kg             

·         Max IV dose 3mg/kg

·         ETT dose 2-3mg/kg

After 2 minutes of CPR defibrillate at 200J and analyze the rhythm

Note:

There is inadequate evidence to recommend the use of Lidocaine in patients who have refractory VT/VF, defined as VT/VF not terminated by defibrillation or that continues to recur after defibrillation during out-of-hospital cardiac arrest or in-hospital cardiac arrest.

Lidocaine is an alternative antiarrhythmic of long-standing and widespread familiarity with fewer immediate side effects than may be encountered with other antiarrhythmics. Lidocaine, however, has no proven short- or long-term efficacy in cardiac arrest

Ventricular Fibrillation Responsive to Defibrillation at 360 J

Reviewed 2/28/16