Respiratory Arrest (Apnea): 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 vasopressorIn case of asystole (cardiac arrest)/PEA (pulseless electrical activity) administration as soon as possible! First-line therapy: treatment of cardiac arrest due to ventricular fibrillation or pulseless VT* after 3rd unsuccessful defibrillation.

Caveat: Early administration (after 1st unsuccessful defibrillation) leads to worse outcome:

  • Proportion who left the hospital alive was lower than in 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%)
Antiarrhythmics Amiodarone For refractory (“unresponsive to therapy“) ventricular fibrillation/pulseless VT* .
Lidocaine 2nd choice after amiodarone
Drugs that should be used only rarely and with a confirmed indication Magnesium In VT/SVT* * ; hypomagnesemia (magnesium deficiency), torsades, digitalis intoxication.
Calcium For hyperkalemia (excess potassium), hypocalcemia (calcium deficiency), calcium antagonist intoxication
Sodium bicarbonate For hyperkalemia (excess potassium), tricyclic antidepressant intoxication.
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
  • See also under “Further Therapy.”