Drugs used during advanced life support resuscitation

1. DRUGS IN
CARDIOPULMONARY
RESUSCITATION

2. OBJECTIVES
Upon completion of this session, you will be able
to:
• state the drugs commonly used in resuscitation
• outline the major actions of these drugs
• list 2 side effects related to the use of the drugs

3. DRUGS USED IN RESUSCITATION
• Adrenaline
• Atropine
• Amiodarone
• Lignocaine
• Adenosine
• Dopamine

4. ACCESS TO DRUG ADMINISTRATION
• Intravenous
-Peripheral or central
• Intra-osseous (2nd preferred route after failed x2 attempts
on IV access)
• Intra-tracheal
– Only if intravenous and intraosseous not available
– “NAVEL”
(Naloxone,Atropine,Vasopressin,Epinephrine,Lidocaine)

5. TECHNIQUE FOR IV DRUG
ADMINISTRATION
• Use upper extremity veins
• Keep the access site elevated
• Each IV drug administration to be followed by
20-30mls bolus of normal saline
• The cannula should be as large as possible
• Use normal saline as the fluid of resuscitation

6. TECHNIQUE FOR ENDOTRACHEAL
DRUG ADMINISTRATION
• Dilute the drug in 10 ml saline
• Thread a long catheter through the ETT
• Stop chest compressions
• Inject the drug through the catheter
• Follow with 3-4 manual lung inflations
• Dosage: 2-2.5x the recommended IV dose

7. INTRAOSSEOUS
• Available for adult usage
• Site: Iliac crest, sternum
• As effective as intravenous line for resuscitation

8. ADRENALINE
1st drug in cardiac arrest

9. ADRENALINE
• Indications:-
VF
Pulseless VT
Pulseless electrical activity (PEA)
Asystole

10. ADRENALINE
• Routes of administration:-
› IV push OR Intraosseus 1mg
Infusion (3mg in 50 mls N/S at 1ml/hr
=1ug/min), titrate accordingly
› ETT (2-2.5X IVdose)

11. ADRENALINE ---- ACTIONS
• increases contractile force of the heart thus
increasing cardiac output
• increases conduction of SA node, AV node and
ventricle thus increasing heart rate
• increases systemic vascular resistance through
peripheral vasoconstriction thus increasing
perfusion pressure

12. ADRENALINE ---- SIDE-EFFECTS
• Ventricular irritability
– tachyarrthymias
• ↑ Myocardial Oxygen demand
- risk of ischaemia and MI
• Cerebrovascular event

13. ATROPINE
• Anticholinergic (parasympatholytic)
– inhibits effect of acetylcholine on SA and AV
node
– increases SA node and AV node conduction
velocity
– decreases effective refractory period AV node
• Increases heart rate and cardiac output

14. ATROPINE
Indication:
• Sinus, atrial or nodal bradycardia with
hemodynamic instability

15. ATROPINE
Routes of administration:-
• IV: 1mg for Acute symptomatic/unstable
bradycardia (Max 3mg)
• ETT: 2-3 mg diluted in 10 mls saline

16. ATROPINE ---- SIDE-EFFECTS
• Tachycardia
• Palpitations
• Paradoxical bradycardia (if dose < 0.5mg)
• Seizure (rare)
• Hypertension (rare)

17. AMIODARONE
• Has characteristics of all 4 antiarrhythmic drug
classes
– affect sodium, potassium and calcium channel
– alpha and beta blocking properties
• Used in BOTH supraventricular and ventricular tachyarrthymias
– Refractory VT/VF
– Stable monomorphic or polymorphic VT
– PSVTs, atrial tachycardia, atrial fibrillation
– Wide complex tachycardia of uncertain origin
– Pre-excited atrial arrhythmia

18. AMIODARONE
• VF, pulseless VT and refractory VT/VF
– Drug of Choice
• IV bolus dose 300 mg
• repeat IV bolus 150 mg in 3-5 mins
followed by IV Infusion 900 mg over 24h
• Other arrhythmias
› IV Infusion 150 mg over 10min
followed by IV infusion 900 mg over 24h

19. LIGNOCAINE
Indication:
• Refractory VT/ VF (when amiodarone is not
available)

20. LIGNOCAINE ---- ACTIONS
• Raises fibrillatory threshold
• enhances the effect of DC shock
• Suppresses automaticity and shortens effective
refractory period and action potential duration
• slows down heart rate
• Inhibits reentry mechanism – halts arrhythmias

21. LIGNOCAINE
• Routes of administration:-
– IV push (1.0 to 1.5 mg/kg)
Additional 0.5-0.75 mg/kg
Max: 3 mg/kg
Infusion 1 gm Lignocaine in 500 ml N/S
30 to 120 ml/hr (1 – 4 mg/min)
– ETT (2-2.5X IV dose)

22. LIGNOCAINE - SIDE-EFFECTS
• Seizures
• Respiratory depression / arrest
• Widening of QRS complexes
• Bradycardia - cardiac arrest

23. ADENOSINE
• A short acting agent that depresses SA node and
AV node function
• Used in narrow complex supraventricular
tachycardia
• Half life : 5 seconds
• Initial dose of 6 mg rapid IV push (may be
repeated at 12 mg )

24. ADENOSINE - SIDE-EFFECTS
• Transient bradycardia or even ASYSTOLE
• Hypotension
• Chest pain
• Dyspnoea
• Bronchospasm (caution in asthma )
• Transient flushing

25. DOPAMINE
Indications:
• cardiogenic shock
• septicaemic shock
• neurogenic shock
• anaphylactic shock
• hypovolaemic shock only after fluid resuscitation
has failed to raise BP

26. DOPAMINE
Route of administration:
• Infusion via central vein

27. DOPAMINE - ACTIONS
Dose dependant effects
-Usual dose: 5– 20ug/kg/min
• Increases myocardial contractility
– Increases cardiac output
• Causes peripheral vasoconstriction
– Increases blood pressure

28. DOPAMINE - SIDE-EFFECTS
• Tachycardia
• Tachyarrhythmias
• Excessive peripheral vasoconstriction

29. SODIUM BICARBONATE
• A significant sodiumload
• 8.4% solution is hypertonic => arterial
vasodilatation and hypotension
• Extravasation => tissue necrosis
• Not to be injected via same IV line as
catecholamines and calcium

30. SODIUM BICARBONATE
• only beneficial in hyperkalaemia
• probably beneficial in
- bicarbonate responsive acidosis
• possibly beneficial in
- protracted cardiac arrest with effective
ventilation
- postresuscitation acidosis with effective
ventilation

31. REVIEW OBJECTIVES
Are you be able to?
• State the drugs commonly used in resuscitation
• outline the major actions of these drugs
• list 2 side effects related to the use of the drugs

32. THANK YOU
NATIONAL COMMITTEE ON RESUSCITATION TRAINING
SUBCOMMITEE FOR ADVANCED LIFE SUPPORT
 Dr Tan Cheng Cheng
 Dr Luah Lean Wah
 Dr Ismail Tan
 Dr Wan Nasrudin
 Dr Chong Yoon Sin
 Dr Priya Gill
 Dr Ridzuan bin Dato’Mohd Isa
 Dr Thohiroh Abdul Razak
 Dr Adi Osman