UMEM Educational Pearls

Category: Cardiology

Title: medications in cardiac arrest

Keywords: ACLS, ALS, advanced cardiac life support, cardiac arrest (PubMed Search)

Posted: 1/3/2010 by Amal Mattu, MD (Updated: 1/5/2010)
Click here to contact Amal Mattu, MD

  Despite the traditional use of intravenous medications such as vasopressors and antiarrhythmics for victims of cardiac arrest, there is actually very little evidence to support these therapies. On the contrary, 2 recent multicenter center studies demonstrated that the use of intravenous medications that are advocated in standard advanced cardiac life support (ACLS) guidelines are ineffective at improving survival to hospital discharge of patients with primary cardiac arrest. In contrast, these medications have been shown to increase hospital admissions, bed and resource utilization, and costs. The only interventions that have been shown to improve meaningful outcomes are rapid defibrillation for shockable rhythms, good compressions, post-resuscitation therapeutic hypothermia, and there's increasing evidence for post-resuscitation cardiac catheterization as well.

In other words, the best thing you can do early for patients with primary cardiac arrrest is to focus on the basics.



Olasveengen TM, Sunde K, Brunborg C, et al. Intravenous drug administration during out-of-hospital cardiac arrest. JAMA 2009;302:2222-2229.

Stiell IG, Wells GA, Field B, et al. Ontario Prehospital Advanced Life Support Study Group. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 2004;351:647-656.