Pulseless VF/VT Part 3

IV Access
· Peripheral IV
· Central line
· Intraossious
· Intratracheal

Peripheral IVs
· Adults peak drug concentrations are lower and circulation times longer
· Does not require interruption of CPR
· Administer the drug by bolus injection and follow with a 20-mL bolus of IV fluid
· Elevate the extremity for 10 to 20 seconds to facilitate drug delivery to the central circulation.

Endotracheal Drug Administration

·         Results in lower blood concentrations than the same dose given via intravascular route

·         Give 2 to 2½ times the recommended IV dose.

·         Providers should dilute the recommended dose in 5 to 10 ml of water or normal saline and inject the drug directly into the endotracheal tube

Note:  If IV or IO access cannot be established, epinephrine, vasopressin, and Lidocaine may be administered by the endotracheal route during cardiac arrest (Class IIb, LOE B). The optimal endotracheal dose of most drugs is unknown, but typically the dose given by the endotracheal route is 2 to 2½ times the recommended IV dose.

Central IV Drug Delivery

·         Peak drug concentrations are higher and drug circulation times shorter

·         Central line placement can interrupt CPR.

·         A central line extending into the superior vena cava can be used to monitor ScvO2 and estimate CPP during CPR, both of which are predictive of ROSC

Intraosseous Drug Delivery

·         Enables drug delivery similar to that achieved by peripheral venous access at comparable doses.

·         Is safe and effective for fluid resuscitation, drug delivery, and  blood sampling

·         Is attainable in all age groups

Drug Therapy- Vasopressors

·         Epinephrine

·         Vasopressin

Note:  Do not interrupt CPR to give medications. The drug should be administered during CPR and as soon as possible after the rhythm is checked.  After 5 cycles (or about 2 minutes) of CPR, analyze the rhythm again and be prepared to deliver another shock immediately if indicated

Drug Therapy: Epinephrine

·         Increases systemic vascular resistance

·         Increases aortic root pressure

·         Increases coronary and cerebral perfusion during CPR

·         Escalating or high doses without demonstrable benefit

·         Drug Therapy: Epinephrine

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

ETT dose 2mg diluted in 10cc of NS

·         Vasopressin 40u IV/IO first or as a second dose to epinephrine

·         After 2 minutes of CPR defibrillate at 200J or higher

Drug Therapy; Vasopressin

·         Potent vasoconstrictor

·         Increases blood pressure and systemic vascular resistance,

·         Increases cardiac output, heart rate, myocardial oxygen consumption, and contractility

Drug Therapy; Vasopressin
·         Vasopressin 40u IV/IO push or Epinephrine 1mg IV
·         May give Vasopressin first or in place of 2nd dose of epinephrine
·         Circulate drug with CPR for up to 2 minutes
·         Defibrillate at 200 J or higher