Therapeutic target
Return of spontaneous circulation (ROSC).
Therapy recommendationsActive ingredients (main indication)
Active ingredient groups | Active ingredients | Special features |
Oxygen | Oxygen | As much and as early as possible |
Sympathomimetics | Epinephrine |
Standard vasopressor In asystole (cardiac arrest)/PEA (pulseless electrical activity) administration as soon as possible! Therapy of first choice:
Caveat: Early administration (after 1st unsuccessful defibrillation) leads to worse outcome:
See also below under “Additional Notes.” |
Antiarrhythmics | Amiodarone | In refractory (“unresponsive to therapy“) ventricular fibrillation/pulseless VT* Amiodarone increased the number of patients reaching the hospital alive. |
Lidocaine | 2nd choice after amiodarone | |
Drugs that should be used only rarely and with a confirmed indication | Magnesium |
Indications:
|
Calcium |
Indications:
Duration of action about 30 min.Stabilizes the resting membrane potential of cardiac myocytes and conduction system, preventing arrhythmias. |
|
Sodium bicarbonate |
Indications:
Onset of action after approximately 10 min, duration of action 2 h. In patients receiving bicarbonate, buffer administration lowered the odds ratio by 36% in terms of survival and by 41% in terms of good neurological outcome |
|
Thrombolysis | Miscellaneous | Not routine use; only for suspected or proven pulmonary embolism |
Beta-blockers | Esmolol | For repeated transition from tachycardia (heart rate greater than 100 beats per minute) to ventricular fibrillation, e.g., due to sniffing agents; CAVE: do not administer adrenaline |
Hypothermia (hypothermia) | Lowering to 32 to 34°C (according to guidelines). | Mild hypothermia at 36 °C may also be sufficient |
* Ventricular tachycardia (ventricular tachycardia) * * Supraventricular tachycardia (abbreviated SV tachycardia or SVT).
Further notes
- Recent studies show a putative positive effect of hypertonic saline on outcome (“result”) during resuscitation (resuscitation); whether this improves long-term survival is not yet clear.
- A U.S. study shows evidence of a survival benefit with combined administration of epinephrine, vasopressin, and glucocorticoid; however, further studies must follow
- Intravenous administration of epinephrine used as a last attempt at therapy after failed cardiovascular resuscitation and defibrillation: meta-analysis showed that epinephrine doubled the odds of return of spontaneous circulation (odds ratio, 2.86), but the odds of discharge with a good neurologic outcome (odds ratio 0.51) was decreased.
- Amiodarone and lidocaine equally improved survival on hospital admission compared with placebo. However, neither amiodarone nor lidocaine improved long-term outcome.
- See also “Other Therapy.