Cardiopulmonary Resuscitation IV: Pharmacological Management

Pharmacologic intervention during Advanced Cardiovascular Life Support, or ACLS, follows specific drug administration protocols based on cardiac arrest rhythms.

Epinephrine is the first-line drug for all pulseless cardiac arrest rhythms, including pulseless electrical activity, or PEA; asystole; ventricular tachycardia, or VT; and ventricular fibrillation, or VF.

It increases coronary and cerebral perfusion via alpha-adrenergic vasoconstriction. Administer 1 mg intravenously or intraosseously every 3 to 5 minutes.

For shock-refractory VT or VF, amiodarone stabilizes the cardiac membrane by blocking potassium, sodium, and calcium channels. Administer 300 mg intravenously, followed by 150 mg if needed.

Lidocaine is an alternative to amiodarone for shock-refractory VT or VF. It blocks sodium channels to suppress arrhythmias.

Lastly, post-cardiac arrest care focuses on hemodynamic stability, using norepinephrine or dopamine for hypotension and atropine for symptomatic bradycardia.