Mikael F Vallentin1, Asger Granfeldt2,3, Mathias J Holmberg4, Lars W Andersen1,4,5. 1. Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus. 2. Department of Anesthesiology, Randers Regional Hospital, Randers. 3. Department of Intensive Care, Randers Regional Hospital, Randers, Denmark. 4. Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus. 5. Department of Anesthesiology, Viborg Regional Hospital, Viborg, Denmark.
Abstract
PURPOSE OF REVIEW: The current narrative review outlines the evidence for the most common drugs given during adult cardiopulmonary resuscitation. RECENT FINDINGS: Two large clinical trials recently made the roles of adrenaline and antiarrhythmic drugs clearer. Adrenaline leads to a substantially higher rate of return of spontaneous circulation and a moderate increase in survival. Amiodarone and lidocaine increase short-term outcomes, and point estimates suggest a small but uncertain effect on long-term survival. There is still a lack of high-quality evidence for other drugs during cardiac arrest such as bicarbonate, calcium, and magnesium, but small-scale randomized clinical trials show no effect. A promising entity may be the combination of vasopressin and glucocorticoids, but external validation of preliminary trials is needed. Data from observational studies and subgroup analyses of trials generally favor intravenous over intraosseous access, while the latter remains a reasonable alternative. SUMMARY: Guidelines for the above-mentioned drugs have been updated yet remain largely unchanged over the last decades. There are still multiple unanswered questions related to drugs during cardiopulmonary resuscitation. On the contrary, only few trials are ongoing.
PURPOSE OF REVIEW: The current narrative review outlines the evidence for the most common drugs given during adult cardiopulmonary resuscitation. RECENT FINDINGS: Two large clinical trials recently made the roles of adrenaline and antiarrhythmic drugs clearer. Adrenaline leads to a substantially higher rate of return of spontaneous circulation and a moderate increase in survival. Amiodarone and lidocaine increase short-term outcomes, and point estimates suggest a small but uncertain effect on long-term survival. There is still a lack of high-quality evidence for other drugs during cardiac arrest such as bicarbonate, calcium, and magnesium, but small-scale randomized clinical trials show no effect. A promising entity may be the combination of vasopressin and glucocorticoids, but external validation of preliminary trials is needed. Data from observational studies and subgroup analyses of trials generally favor intravenous over intraosseous access, while the latter remains a reasonable alternative. SUMMARY: Guidelines for the above-mentioned drugs have been updated yet remain largely unchanged over the last decades. There are still multiple unanswered questions related to drugs during cardiopulmonary resuscitation. On the contrary, only few trials are ongoing.