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:
|
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.”