ACLS drugs used during resuscitation

In this review, I have focused on the relatively small number of drugs used in cardiac arrest, and, specifically, in ventricular tachycardia, ventricular fibrillation, and asystole. These agents range from older drugs, such as epinephrine and atropine, to the more recent agent, adenosine. Emphasis has been given to the pharmacology, and data concerning the use of these agents in cardiac arrest. Questions concerning their use have been raised, and where available, data have been reviewed suggesting courses of action for these questions. Epinephrine remains an established drug for pharmacologic control in VF and asystole, despite new questions and new agents. Although pure α agonists have shown evidence of giving better subendocardial blood flow than epinephrine, questions requiring further study remain with these agents. Higher doses than the standard, fixed 1.0 mg in cardiac arrest have not been shown to result in better rates of survival. Lidocaine is the drug of choice in treating ventricular ectopy, VT, and VF. The prophylactic use of lidocaine in suspected acute MI is not supported by a risk-benefit analysis, and its prophylactic use in confirmed acute MI can be debated, given the prevalence of VF in acute MI and the success of defibrillation. Procainamide is a second-line drug for treatment of PVCs and recurrent VT when lidocaine is contraindicated or has failed. Bretylium is another second-line drug for treatment of VT and VF unresponsive to defibrillation, epinephrine, and lidocaine. Atropine is useful for treatment of symptomatic sinus bradycardia in acute MI, with a dose of 0.04 mg/kg, or 3.0 mg, usually sufficient to produce complete vagal blockade of the SA node. The efficacy of atropine for asystole is not well supported by available data, although the drug is not contraindicated and may be helpful. Sodium bicarbonate has not been shown to improve mixed venous acidemia indicative of poor tissue oxygenation, without a ROSC and improved tissue perfusion secondary to restored cardiac output. Adenosine is the drug of choice for treatment of narrow complex PSVT, especially of uncertain origin. It is rapidly metabolized, with a half-life of only seconds.