Drug treatment of arrhythmias during cardiopulmonary resuscitation: A statement for the advanced life support working party of the European resuscitation council

In October of 2010, the American Heart Association (AHA) published the 2010 Guidelines on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. These guidelines place significant emphasis on 5 major areas of therapy in patient with cardiac arrest, including immediate recognition and activation of the emergency response team, effective chest compressions, rapid defibrillation, effective advanced life support (ALS), and integrated postresuscitation care. “Effective ALS” includes the placement of an advanced airway, establishment of parenteral access, and the administration of cardioactive medications. Advanced life support encompasses only 1 of these 5 major areas of cardiac arrest intervention—in sharp contrast to past renditions of the AHA guidelines in which ALS was significantly emphasized. In fact, recent research and the AHA guidelines note that ALS therapy is less important than previously thought. This article will briefly review the evidence regarding the use of the 5 principal medications—epinephrine, vasopressin, atropine, lidocaine, and amiodarone—used in Advanced Cardiac Life Support cardiac arrest algorithm.

Objective: To determine if the appointment of a Resuscitation Training Officer improves survival to discharge from in-hospital ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. Design: A 22-month prospective study. Setting: A 1100-bed teaching hospital. Subjects: All inpatients suffering ventricular fibrillation or ventricular tachycardia cardiorespiratory arrests. Interventions: Appointment of a Resuscitation Training Officer at start of study, who introduced coordinated resuscitation training for all staff. Main outcome: Survival to discharge. Result: Improvement in survival to discharge of 20–75% (P<0.03, Spearman Rank Correlation test). Conclusion: Appointment of a Resuscitation Training Officer is associated with improved survival to discharge in ventricular fibrillation and ventricular tachycardia in-hospital cardiac arrest.

[Utstein Style Writing Group: Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: The in-hospital “Utstein style.” Ann Emerg Med May 1997;29:650-679.]