Medications Used in treatment of cardiac arrest Epinepherine Epinephrine hydrochloride are proven beneficial in patients during cardiac arrest, primarily because of its alfa adrenergic receptor-stimulating properties.The alfa adrenergic effect of epinephrine can lead to increase coronary and cerebral perfusion pressure during CPR. However epinepherine also have beta adrenergic effects that lead to increase myocardial wor and reduce subendocardial perfusion The dosage use in managing cardiac arrest is ! mg of epinephrine given intravenously every " to five minutes. Higher doses are indicated to treat problems such as calcium channel bloc er to#ication. $f epinepherine failed to be administered intravenously, it can also be administered via endotracheal route at doses of % to %.& mg. Epinepherine are mainly given in cases of ventricular fibrilation and puleless ventricular tachycardiac.
Vasopressin 'asopressin is a nonadrenergic peripheral vasoconstrictor that causes coronary and renal vasoconstriction. 'asopressin effects have shown to differ from those of epinephrine in cardiac arrest, one dose of vasopressin () * given intravenous may replace either the first dose of epinephrine in treatment of pulseless arrest.
Atropine +tropine sulfate reverses cholinergic-mediated decreases in heart rate, systemic vascular resistance, and blood pressure. +dministrations of atropine for assystole is supported by retrospective review of intubated patients with refractory assystole who showed improve survival
to hospital with atropine. +tropine is ine#pensive, easy to administer and has few side effects. Thus it can be considered for cardiac arrest patients with assystole and pulseless electrical activity. The recommended dose of atropine for cardiac arrest patient is ! mg $', which can be repeated every " to & minutes with ma#imum total of " doses if the asystole persists.
Amiodarone +miodarone can effect sodium, potassium and calcium channel plus have the abilities to bloc both alfa and beta adrenergic receptor. $n usage involve in the treatment of ventricular fibrillation and pulseless ventricular tachycardiac which is unresponsive to shoc delivery, CPR and vasopressor. +miodarone can be administered with initial dose of ")) mg via $' followed by onedose of !&) mg $'.
Lidocaine The usage of lidocaine for ventricular arrhythmias was documented by initial studies in animals and e#trapolation from the historic use of the drug to suppress premature ventricular contractions and prevent ', after acute myocardial infarction. -idocaine is an alternative anti arrhythmic drug to amiodarone, with the initial dose is !to !.& mg. g $'. However if ', or pulseless 'T persist additional ).& to )./& g. g $' can be administered at & to !) minute interval 0with ma#imum dose of " mg. g1.
Magnesium Two studies show that administration of magnesium via $' effectively terminate torsades de pointes 0irregular.polymorphic 'T associated with prolonged 2T interval1.However not li ely to be effective in terminating irregular.polymorphic 'T in patients with a normal 2T interval. ,or the treatment of torsades de pointes, magnesium sulfate are given at dose of ! to % g diluted
in !) ml de#trose &3 via $' over & to %) minutes.
Potentially Beneficial Therapies Fibrinolysis +dults have been successfully resuscitated following administrationof fibrinolytics 0tP+1 after initial failure of standard. However there is insufficient evidence to recommend for or againstthe routine use of fibrinolysis for cardiac arrest.CPR techni4ues, particularly when the condition leading tothe arrest was acute pulmonary embolism or other presumed cardiac cause.
Inter entions !ot "upported By #utcome E idence Procainamide in VF and Pulseless VT +dministration of procainamide in cardiac arrest is limited by the need for slow infusion and by uncertain efficacy in emergent. !orepinepherine 5orepinephrine has been studied in only a limited fashion for treatment of cardiac arrest. Human data is limited, but it suggests that norepinephrine produces effects e4uivalent to epinephrine in the initial resuscitation of cardiac arrest. $n one study showed that norepinephrine was associated with no benefit and a trend toward worse neurologic outcome. Electrolyte Therapies in Arrest $hythms Magnesium 6ne studies in adult cardiac arrest and animal studies showed no increase in the rate of Return of spontaneous circulation when magnesium was routinely given during CPR. However
administrationof magnesium can be considered for treatment of torsades de pointes, but it is not effective for treatment of cardiac arrest from other causes. $outine Administration of IV Fluids %uring &ardiac Arrest There is insufficient evidence to recommend routine administration of fluids to treat cardiac arrest with normovolemic .,luids should be infused if hypovolemia is suspected.