Pulseless VF/VT Part 4


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 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

Note: 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

Magnesium 50%
·         1-2g IV/IO diluted in 10cc of NS
·         Indicated for hypomagnesemia
·         Indicated for Torsades de pointe

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


References

1.    Aehlert, Barbara. ACLS Quick Review Study Guide, 2nd edition.  Mosby, Inc. St. Louis, Mo. 1994.

2.    AHA (2010) Highlights of the 2010 American Heart Association Guidelines for CPR and ECC, p. 1. www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf ·

3.    AHA (2010) Cardiopulmonary Resuscitation (CPR) Statistics. Retrieved December 17, 2010 from: http://www.americanheart.org/presenter.jhtml?identifier=4483.

4.    AHA Website (2010) Get With the Guidelines-Resuscitation. Retrieved December 17, 2010 from: http://www.heart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelines-Resuscitation/Get-With-The-Guidelines-Resuscitation_UCM_314496_SubHomePage.jsp.

5.    AHA (2010) CPR & Sudden Cardiac Arrest (SCA) Fact Sheet, as of April 26, 2010.

6.    Morrison LJ et al. (2010) Part 8: Advanced Life Support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations, Circulation, 122:S345–S421. 

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