Merck Manual

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Drugs and Defibrillation Used in Cardiopulmonary Resuscitation

Drugs and Defibrillation Used in Cardiopulmonary Resuscitation





Low dose (0.01 mg/kg) every 3–5 min early in CPR; high dose (0.1 mg/kg) after prolonged CPR; 10 times the dose may be required when given intratracheally

Asystole, ventricular fibrillation, PEAb


0.1 mL/5 lb (0.5 mg/mL solution)

Sinus bradycardia, asystole, or PEA associated with high vagal tone

Sodium bicarbonate

1 mEq/kg (1 mEq/mL solution)

Severe metabolic acidemia associated with prolonged (>10–15 min) cardiopulmonary resuscitation efforts (must be adequately ventilated to be effective), hyperkalemia

Calcium gluconate

1 mL/5–10 kg (2% solution without epinephrine)

Routine use not recommended; treat cases with documented hypocalcemia (or severe hyperkalemia)


5 mg/kg

Refractory ventricular fibrillation or pulseless ventricular tachycardia

Magnesium sulfate

30 mg/kg

Hypomagnesemia, torsades de pointes


2–4 mg/kg

Pulseless ventricular tachycardia, ventricular fibrillation resistant to defibrillation


0.4–0.9 U/kg

Combined with or as a substitute for epinephrine every 3–5 min (asystole, bradycardia, PEA)


0.02–0.04 mg/kg

To reverse opioids


4–6 joules/kg external (monophasic), 2–4 joules/kg external (biphasic), 0.2–1 joules/kg internal

Single shock, resume CPR efforts immediately after for one cycle (2 min), dose escalation may occur

a Dosage should be doubled if given via intratracheal route.

b PEA = pulseless electrical activity