Drugs

Few drugs are necessary for first line cardiac arrest management. Drugs should be given via a large vein since vasoconstriction and poor flow create delay in injections given via small peripheral veins reaching the central circulation. Access should be secured early during the resuscitation; if venous access cannot be secured double or triple doses of drugs may be given via the endotracheal tube.

Epinephrine

The a constrictor effects predominate during cardiac arrest, helping to maintain diastolic blood pressure and thus coronary and cerebral perfusion. Epinephrine should be given irrespective of rhythm at 1mg (10ml of 1:10,000 solution) every 10 CPR sequences.

Vasopressin

A recent randomized controlled trial comparing vasopressin and epinephrine showed improved outcomes with vasopressin for patients in asystole.

Atropine

A single 3mg dose is given early in asystole.

Calcium chloride

Used in electromechanical dissociation if there is hyperkalaemia, hypocalcaemia or calcium antagonist use. A dose of 10ml of a 10% solution is usual. The main disadvantage of calcium is the reduction of reperfusion of ischaemic brain and promotion of cytosolic calcium accumulation during cell death.

Bicarbonate

Only used if resuscitation is prolonged to correct temporarily a potentially lethal pH. A dose of 50ml of 8.4% solution is given. The main disadvantage is that intracellular and respiratory acidosis are exacerbated unless ventilation is increased and the cause of the metabolic acidosis is not corrected.

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