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, 2^nd 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.

Downloaded December 17, 2010 from: http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/CPR-Statistics_UCM_307542_Article.jsp.

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.