[Drug therapy in cardiopulmonary resuscitation].
In the year 2000, new international guidelines for cardiopulmonary resuscitation (CPR) were published by the American Heart Association, and the European Resuscitation Council. These guidelines are evidence-based, indicating that these recommendations are based primarily on interpretation of data from clinical studies. Levels of recommendation range from class I (proven safe and useful), class IIa (intervention of choice), IIb (alternative intervention), indeterminate (research stage), and class III (unacceptable, no benefit). Administration of drugs during CPR should be performed intravenously or intraosseously (class IIa) or, as a second-line approach, endotracheally (class IIb). Due to lack of evidence, the standard dose of 1 mg epinephrine to treat ventricular fibrillation, pulseless electrical activity, or asystole was categorized as class indeterminate; while a single dose of 40 units vasopressin to treat adults with shock-refractory ventricular fibrillation received a IIb recommendation. Owing to a lack of clinical data, the use of vasopressin was neither recommended to treat adults with pulseless electrical activity or asystole, nor for the use in children. Both endothelin and calcium were not recommended for routine use (class indeterminate). Careful titration of acid-base status with 1 mL/kg 8.4% sodium bicarbonate should only be administered if indicated by blood gas analysis (class indeterminate). If 1 mg epinephrine fails to be effective in adult patients with pulseless electrical activity or asystole, 1 mg atropine can be administered (class indeterminate). Regarding antiarrhythmic drugs, 300 mg amiodarone (class IIb) showed the best results in shock-refractory ventricular fibrillation. The postresuscitation phase has the goal to achieve the best possible neurological performance after return of spontaneous circulation, which requires careful optimization of organ functions.
Wenzel
V
V
Universitätsklinik für Anaesthesie und Allgemeine Intensivmedizin, Leopold-Franzens-Universität Innsbruck, Osterreich. volker.wenzel@uibk.ac.at
Krismer
A C
AC
Mayr
V D
VD
Voelckel
W G
WG
Strohmenger
H U
HU
Lindner
K H
KH
D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D016887:Cardiopulmonary Resuscitation; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D000075202:Contraindications; D004333:Drug Administration Routes; D019317:Evidence-Based Medicine; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000188:drug therapy*
D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents