APPENDIX A: Drugs used during the treatment of cardiac arrest.
The effective management of cardiac arrest involves timely administration of drugs alongside high-quality CPR and defibrillation. This section details the key drugs used in resuscitation, their indica…
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Overview
The effective management of cardiac arrest involves timely administration of drugs alongside high-quality CPR and defibrillation. This section details the key drugs used in resuscitation, their indications, doses, and mechanisms of action.
Adrenaline (Epinephrine)
Role in Cardiac Arrest
A critical vasopressor that increases coronary and cerebral perfusion pressure during CPR.
Enhances myocardial contractility and promotes the return of spontaneous circulation (ROSC).
Indications & Administration
Given for shockable (VF/pVT) and non-shockable (asystole/PEA) cardiac arrests.
Dose: 1 mg IV/IO every 3-5 minutes during cardiac arrest.
First dose timing:
After the third shock for shockable rhythms (VF/pVT).
Immediately after vascular access for non-shockable rhythms (asystole/PEA).
Adverse Effects: Can cause hypertension, tachycardia, and arrhythmias post-ROSC.
Amiodarone
Role in Cardiac Arrest
A class III antiarrhythmic that stabilises cardiac membranes by blocking potassium channels.
Used to terminate shock-resistant ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT).
Indications & Administration
Dose: 300 mg IV/IO after the third shock for persistent VF/pVT.
A repeat dose of 150 mg may be given if VF/pVT persists.
Always followed by a flush to ensure drug delivery.
Contraindications: Avoid in cases of severe bradycardia, heart block, or hypotension.
Lidocaine (Alternative to Amiodarone)
Role in Cardiac Arrest
A sodium channel blocker used as an alternative to amiodarone for VF/pVT refractory to defibrillation.
It reduces myocardial excitability and suppresses ectopic ventricular activity.
Indications & Administration
Dose: 1 mg/kg IV/IO, followed by further doses up to 3 mg/kg if needed.
Do NOT use lidocaine if amiodarone has already been administered.
Adverse effects: Can cause neurological toxicity, including seizures and altered consciousness in overdose.
Magnesium Sulphate
Role in Cardiac Arrest
Primarily used for Torsades de Pointes (polymorphic VT associated with QT prolongation).
Helps in cases of hypomagnesaemia, which can lead to arrhythmias.
Indications & Administration
Dose: 2 g IV/IO over 1-2 minutes for Torsades de Pointes or suspected hypomagnesaemia.
Adverse effects: High doses may cause hypotension, respiratory depression, and cardiac arrest.
Calcium Chloride
Role in Cardiac Arrest
Used in specific cases, including hyperkalaemia, hypocalcaemia, and calcium channel blocker overdose.
Helps restore cardiac excitability and contractility.
Indications & Administration
Dose: 10 mL of 10% calcium chloride IV/IO for severe hyperkalaemia or overdose.
Not routinely given in cardiac arrest unless indicated.
Adverse effects: Can cause tissue necrosis if extravasation occurs.
Sodium Bicarbonate
Role in Cardiac Arrest
Buffering agent used to correct severe metabolic acidosis.
Only considered in prolonged resuscitation efforts or specific cases.
Indications & Administration
Dose: 50 mmol IV/IO slow push, repeated as necessary.
Used for hyperkalaemia, tricyclic antidepressant overdose, or prolonged cardiac arrest with severe acidosis.
Routine use is NOT recommended due to risks of worsening intracellular acidosis.
Naloxone (Opioid Reversal)
Role in Cardiac Arrest
Used to reverse opioid-induced respiratory depression in suspected opioid overdose.
Not a primary drug for cardiac arrest unless opioid toxicity is suspected.
Indications & Administration
Dose: 0.4–2 mg IV/IO every 2-3 minutes as needed (max 10 mg).
Considered in cardiac arrest due to suspected opioid toxicity.
Summary Table: Drug Use in Cardiac Arrest
Drug
Indication
Dose & Route
Key Considerations
Adrenaline
VF/pVT, Asystole, PEA
1 mg IV/IO every 3-5 min
Give immediately in non-shockable rhythms. Delays worsen survival.
Amiodarone
Shock-resistant VF/pVT
300 mg IV/IO (after 3rd shock), then 150 mg
Avoid in severe bradycardia/hypotension.
Lidocaine
Alternative to Amiodarone for VF/pVT
1 mg/kg IV/IO, up to 3 mg/kg
Do not use if amiodarone was already given.
Magnesium Sulphate
Torsades de Pointes, Hypomagnesaemia
2 g IV/IO over 1-2 min
Can cause hypotension, respiratory depression.
Calcium Chloride
Hyperkalaemia, Hypocalcaemia, CCB overdose
10 mL of 10% CaCl IV/IO
Not routine. Avoid extravasation.
Sodium Bicarbonate
Severe acidosis, TCA overdose, hyperkalaemia
50 mmol IV slow push
Not routinely used. Can worsen acidosis.
Naloxone
Opioid toxicity with respiratory depression
0.4-2 mg IV/IO
Used in suspected opioid overdose.
Key Takeaways
✔ Drugs are secondary to high-quality CPR and defibrillation in cardiac arrest. ✔ Adrenaline is the most critical drug, but timing matters—give early in non-shockable rhythms and after the third shock in shockable rhythms. ✔ Antiarrhythmic drugs (amiodarone or lidocaine) should be used selectively. ✔ Reversible causes (e.g., hyperkalaemia, opioid overdose, metabolic acidosis) guide additional drug therapy. ✔ Routine administration of sodium bicarbonate and calcium is NOT recommended unless specifically indicated.