Drugs in Cardiac Arrest - Resuscitation Emergency Management

Drugs in Cardiac Arrest

·        No drug has been shown to consistently improve patient survival after cardiac arrest. CPR, defibrillation and airway control are therefore most important

·        Adrenaline: peripheral vasoconstriction raises afterload, aids cardiac perfusion in diastole during CPR. Short duration of action ® give 1 mg every 3 minutes. For kids, 10 mg/kg, subsequent doses 100 mg/kg. Effect wears off as local mediator dilator effects predominate in distal arteries

·        Sodium bicarbonate: but major acidosis is usually respiratory, in which case bicarbonate ® ­CO2 so will make this worse. Consider after prolonged hypoxia. Also in severe ketoacidosis. Don‟t give via endotracheal tube

·        Lignocaine, 1 mg/kg: for ventricular ectopy and stable ventricular tachycardia. No clear evidence of value in VF. ­Shock energy required for successful defibrillation. Makes VF less likely – but harder to get out of

·        Calcium: if massive blood transfusion will be calcium depleted

Care Following Arrest

·        Transfer to ICU or CCU

·        May need short period of elective ventilation

·        Monitor cardiac rhythms, urine output, cerebral oedema, acid-base balance

·        Prognosis of neurological function often clear from 24 hours after arrest