Thrombolysis and other drugs during cardiopulmonary resuscitation.
OBJECTIVE
No specific drug therapy has been shown to improve long-term survival after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This study reviews recent studies on drugs during cardiopulmonary resuscitation.


RESULTS
Epinephrine is the first-line vasopressor during cardiopulmonary resuscitation. Arginine vasopressin may be more effective than epinephrine in patients presenting with asystole or as a second vasopressor in refractory cardiac arrest. Sodium bicarbonate should not be 'blindly' administered during cardiopulmonary resuscitation unless an arterial blood gas analysis can be obtained or after prolonged unsuccessful cardiopulmonary resuscitation. Amiodarone may improve short-term survival. Thrombolytic therapy during cardiopulmonary resuscitation may be beneficial if a pulmonary embolism or acute myocardial infarction is suggested to be the cause of cardiac arrest.


CONCLUSIONS
Epinephrine is the vasopressor of first choice for routine use during cardiopulmonary resuscitation. Arginine vasopressin may be considered in patients presenting with asystole or who are unresponsive to initial treatment with epinephrine. Amiodarone should be used in shock-refractory ventricular fibrillation. Although not recommended for routine use, thrombolytic therapy during cardiopulmonary resuscitation may be considered in patients with suspected pulmonary embolism or after unsuccessful conventional cardiopulmonary resuscitation in patients with a presumably thrombotic cause of cardiac arrest.
Spöhr
Fabian
F
Department of Anaesthesiology and Postsurgical Intensive Care, University of Cologne, Cologne, Germany.
Wenzel
Volker
V
Böttiger
Bernd W
BW
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001127:Arginine Vasopressin / Q000627:therapeutic use; D001285:Atropine / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation; D004837:Epinephrine / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006323:Heart Arrest / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D006801:Humans; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D005343:Fibrinolytic Agents; D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D001285:Atropine; D017693:Sodium Bicarbonate; D004837:Epinephrine