Merck Manual

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Drugs and Defibrillation Used in Cardiopulmonary Resuscitation

Drugs and Defibrillation Used in Cardiopulmonary Resuscitation

Drug

IV Dosagea

Indications

Epinephrine

Low dosage (0.01 mg/kg);

High dosage (0.1 mg/kg) after prolonged CPR;

10 times the dosage may be required when given IT

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

Vasopressin

0.4–0.9 U/kg

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

Atropine

0.04 mg/kg;

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

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

Lidocaine

2–4 mg/kg

Pulseless ventricular tachycardia, ventricular fibrillation resistant to defibrillation

Sodium bicarbonate

1 mEq/kg (1 mEq/mL solution)

Severe metabolic acidemia (pH < 7.0) associated with prolonged (>10–15 minutes) CPR 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

Amiodarone

5 mg/kg

Refractory ventricular fibrillation or pulseless ventricular tachycardia

Magnesium sulfate

30 mg/kg

Hypomagnesemia, torsades des pointes

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 for one cycle (2 minutes) and reassess ECG, after which dosage escalation by 50% may occur (maximum dosage of 10 joules/kg)

Reversal Agents

Naloxone

0.02–0.04 mg/kg

To reverse opioids

Flumazenil

0.01–0.02 mg/kg

To reverse benzodiazepines

Atipamezole

0.05 mg/kg (or same volume as dexmedetomidine)

To reverse dexmedetomidine

a Dosage should be doubled if given via intratracheal route.

b PEA = pulseless electrical activity