ACLS review: asystole part 4

Drug therapy 
Epinephrine

Note: Available evidence suggests that the routine use of atropine during PEA or asystole is unlikely to have a therapeutic benefit. For this reason, atropine has been removed from the Cardiac Arrest Algorithm.

To date no placebo-controlled trials have shown that administration of any vasopressor agent at any stage during management of VF, pulseless VT, PEA, or asystole increases the rate of neurologically intact survival to hospital discharge. There is evidence, however, that the use of vasopressor agents is associated with an increased rate of ROSC.

Drug Therapy: Epinephrine

· Epinephrine 1mg (1:10,000 solution) IV/IO q3-5min

· ETT dose 2mg diluted in 10cc of NS

· Increases systemic vascular resistance (vasoconstriction)

· Increase coronary and cerebral perfusion pressures during CPR

· Escalating or high doses without demonstrable benefit

· After drug delivery and approximately 5 cycles (or about 2 minutes) of CPR then recheck the rhythm 

Vasopressin is no longer recommended

Reviewed 2/28/16