Drugs and Defibrillation Used in Cardiopulmonary Resuscitation

Epinephrine^a

Low dosage (0.01 mg/kg); equivalent to 0.01 mL/kg of 1 mg/mL or 1:1,000 concentration

Administered every 3–5 minutes early in CPR (every other cycle) for asystole, PEA

Vasopressin^a

0.8 U/kg; equivalent to 0.04 mL/kg of 20 U/mL concentration

As an alternative to epinephrine every 3–5 minutes (every second BLS cycle) for asystole, PEA

Atropine^a

0.05 mg/kg;

0.1 mL/kg of 0.4–0.54 mg/mL concentration

Sinus bradycardia, arrest associated with high vagal tone. Varying concentration (0.4 vs 0.54 mg/mL is likely insignificant). Single dose only, administered early during CPR.

Lidocaine^a (dogs only)

2 mg/kg; equivalent of 0.1 mL/kg of 20 mg/mL or 2% concentration

Pulseless ventricular tachycardia, ventricular fibrillation refractory to defibrillation, suggested after 2 or more shocks

Sodium bicarbonate

1 mEq/kg (1 mEq/mL solution)

Prolonged CPR efforts (> 15 min), especially if severe metabolic acidemia (pH < 7.0); must be adequately ventilated to be effective, hyperkalemia

Amiodarone (cats)

5 mg/kg; equivalent to 0.1 mL/kg of 50 mg/mL solution

Pulseless ventricular tachycardia, ventricular fibrillation refractory to defibrillation, suggested after 2 or more shocks

Esmolol

0.5 mg/kg; equivalent to 0.05 mL/kg of 10 mg/mL solution administered over 10 min, followed by a 50 mcg/kg/min CRI

Pulseless ventricular tachycardia, ventricular fibrillation refractory to defibrillation, suggested after 2 or more shocks

Defibrillation

4–6 J/kg external monophasic;

2–4 J/kg external biphasic;

0.5–1 J/kg internal monophasic;

0.2–0.4 J/kg internal biphasic

Single shock for ventricular fibrillation or pulseless ventricular tachycardia; resume CPR efforts immediately after defibrillation for one full cycle (2 min) before reassessing ECG. If shockable rhythm still present, dose is doubled once and maintained at that level for subsequent defibrillation attempts.

Reversal Agents

IV dosage

Naloxone

0.04 mg/kg; equivalent to 0.1 mL/kg of 0.4 mg/mL solution

To reverse opioids (fentanyl, methadone, hydromorphone, etc)

Flumazenil

0.01 mg/kg; equivalent to 0.1 mL/kg of 0.1 mg/mL solution

To reverse benzodiazepines (midazolam, diazepam, etc)

Atipamezole

0.1 mg/kg (or same volume as dexmedetomidine); equivalent to 0.02 mL/kg of 5 mg/mL solution

To reverse dexmedetomidine, medetomidine