A Narrative Review of Drug Therapy in Adult and Pediatric Cardiac Arrest

TL;DR

This review summarizes the drugs used during cardiac arrest in adults and children, focusing on their roles, effectiveness, and current guidelines.

Contribution

The paper provides an up-to-date narrative review of drug therapy in cardiac arrest, emphasizing current recommendations and controversies.

Findings

Epinephrine is the only recommended vasopressor during cardiac arrest.

Amiodarone and lidocaine are recommended antiarrhythmics for shockable rhythms.

Calcium, sodium bicarbonate, and magnesium are no longer recommended due to lack of benefit.

Abstract

Drugs are used during cardiopulmonary resuscitation (CPR) in association with
chest compressions and ventilation. The main purpose of drugs during
resuscitation is either to improve coronary perfusion pressure and myocardial
perfusion in order to achieve return of spontaneous circulation (ROSC). The aim
of this up-to-date review is to provide an overview of the main drugs used during
cardiac arrest (CA), highlighting their historical context, pharmacology, and the
data to support them. Epinephrine remains the only recommended vasopressor.
Regardless of the controversy about optimal dosage and interval between doses in
recent papers, epinephrine should be administered as early as possible to be the
most effective in non-shockable rhythms. Despite inconsistent survival outcomes,
amiodarone and lidocaine are the only two recommended antiarrhythmics to treat
shockable rhythms after defibrillation. Beta-blockers have also been recently
evaluated as antiarrhythmic drugs and show promising results but further
evaluation is needed. Calcium, sodium bicarbonate, and magnesium are still widely
used during resuscitation but have shown no benefit. Available data may even
suggest a harmful effect and they are no longer recommended during routine CPR.
In experimental studies, sodium nitroprusside showed an increase in survival and
favorable neurological outcome when combined with enhanced CPR, but as of today,
no clinical data is available. Finally, we review drug administration in
pediatric CA. Epinephrine is recommended in pediatric CA and, although they have
not shown any improvement in survival or neurological outcome, antiarrhythmic
drugs have a 2b recommendation in the current guidelines for shockable rhythms.

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