Drugs in Resuscitation

Abstract

Cardiac arrest (CA) is defined as the sudden cessation of spontaneous circulation and ventilation. Unfortunately, survival rates of both out of hospital and in hospital cardiac arrest remain low and merely unchanged over the last 30 years. Cardiopulmonary resuscitation (CPR) is an attempt to restore effective, spontaneous circulation and ventilation through a variety of interventions including early defibrillation, chest compressions, advanced airway management, pharmacological therapy and effective post-resuscitation treatment, once return of spontaneous circulation (ROSC) has been achieved. Both, European Resuscitation Council (ERC) and American Heart Association (AHA) have published detailed guidelines in an attempt to incorporate recent scientific advances in a variety of topics underpinning CPR.

The major concepts of these guidelines are the increased emphasis on high quality, minimally interrupted chest compressions of adequate rate and depth, avoidance of hyperventilation, early defibrillation for specific heart rhythms with minimization of the pre-shock pause and greater detail and importance on the treatment of the post-cardiac arrest syndrome.

Pharmacologic interventions continue to be a fundamental part of advanced life support, although there are no clinical data indicating that any drug improves long term survival after CA. In addition, there is inadequate evidence to define the optimal timing, dose or order for drug administration. The primary goal of pharmacologic therapy during CA is to facilitate restoration and maintenance of a perfusing and spontaneous rhythm. Vasopressors and antiarrhythmics are the main drug categories used in CPR algorithms... (excerpt)