Cardiac Arrest Resuscitation Medications and Protocols

During cardiac arrest, timely administration of specific medications can significantly improve patient outcomes. The primary drugs used in resuscitation include epinephrine, dopamine, metaraminol, and norepinephrine, each playing a distinct role in restoring cardiovascular function.

Key Medications Used in Cardiac Arrest

1. Epinephrine: The First-Line Treatment

Epinephrine remains the cornerstone of drug therapy during cardiac arrest. It acts on both alpha and beta receptors, with a strong effect on beta-1 receptors located in the myocardium. By stimulating these receptors, epinephrine enhances myocardial contractility and increases cardiac output. Its ability to improve coronary and cerebral perfusion makes it the preferred medication in advanced cardiac life support (ACLS) protocols.

2. Vasopressors: Dopamine, Metaraminol, and Norepinephrine

Following initial resuscitation, vasopressor agents such as dopamine, metaraminol, and norepinephrine may be used to support blood pressure. These drugs induce peripheral vasoconstriction, which helps maintain or elevate systemic vascular resistance. They are especially useful in stabilizing hemodynamics after return of spontaneous circulation (ROSC).

3. Sodium Bicarbonate for Acidosis Management

During cardiac arrest, prolonged ischemia can lead to metabolic acidosis due to lactic acid buildup and carbon dioxide retention. In such cases, 5% sodium bicarbonate may be administered intravenously to correct acid-base imbalances. However, its use is typically reserved for confirmed cases of severe acidosis or hyperkalemia, as overuse may lead to complications.

4. Intravenous Fluids for Volume Expansion

Alongside medication administration, establishing intravenous access and initiating fluid therapy is crucial. Normal saline or Lactated Ringer's solution are commonly used to restore intravascular volume, support blood pressure, and facilitate drug delivery during resuscitation efforts.

Comprehensive Resuscitation Approach

Medication use is just one component of effective cardiac arrest management. Immediate cardiopulmonary resuscitation (CPR) and artificial ventilation are essential. In-hospital resuscitation often involves high-quality chest compressions combined with bag-valve-mask ventilation or advanced airway support using a manual resuscitator.

Post-Resuscitation Evaluation

After resuscitation, it is critical to assess the effectiveness of interventions. Key indicators of successful resuscitation include the return of spontaneous circulation (ROSC), palpable central pulse, audible heart sounds, resumption of spontaneous breathing, improved level of consciousness, pupillary response normalization, and purposeful limb movement in response to commands.

Healthcare providers should continue post-cardiac arrest care with a focus on optimizing oxygenation, managing hemodynamics, and identifying the underlying cause of the event to prevent recurrence.