Cardiac Arrest: Drug Therapy

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:

  • Proportion who left the hospital alive was lower than for other patients (31% vs 48%).
  • Less likely to have a spontaneous circulation (67% vs. 79%).
  • Less likely to have a good functional outcome at discharge (25% vs. 41%)

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:

  • VT/SVT* *
  • Hypomagnesemia (magnesium deficiency)
  • Torsades
  • Digitalisintoxication
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.