Take Home Points
- In cardiac arrest, the most important interventions are to deliver electricity quickly when it’s indicated and to administer good high-quality compressions with minimal interruptions to maximize your compression fraction.
- Medications like epinephrine and amiodarone have never been shown to improve good neurologic outcomes in the ACLS recommended doses. Don’t focus on them.
- Consider pre-charging your defibrillator to minimize pauses in CPR and maximize your chance for ROSC
- Finally, remember that as Emergency Physicians, we are specialists in the resuscitation of cardiac arrests. ACLS is just a starting point. Push your understanding of taking care of these patients so you can deliver the best care possible
Core EM: Ventricular Tachycardia
Core EM: A Simplified Approach to Tachydysrhythmias
Core EM: Amiodarone, Lidocaine or Placebo in OHCA
emDocs.net: Epinephrine in Cardiac Arrest
REBEL EM: Beyond ACLS: Pre-Charging the Defibrillator
ACLS VFib and VTach Algorithm
Driver BE et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation. Resuscitation 2014; 85(10): 1337-41. PMID: 25033747
Kudenchuk PJ et al. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. NEJM. 2016; PMID: 27043165
Laina A et al. Amiodarone and Cardiac Arrest: Systematic Review and Meta-Analysis. Int J Cardiol 2016; 221: 780-8. PMID: 27434349