ACLS antiarrhythmic question

[Sharktooth]

ACLS was offered to all providers at my service. I have a question about Antiarrhythmics. I was getting conflicting answers from some of the medics.

In VF/tach if you get a pulse back after the first or second defibrillation, prior to antiarrhythmics .....are they still given once pulses return? Like an infusion or a drip to prevent them from going back into the arrhythmia?

Or does induced hypothermia take the place of the amiodarone infusion and drip once ROSC is achieved? Or are they given during induced hypothermia?

:blink::unsure:

 

[KellyBracket]

ACLS was offered to all providers at my service. I have a question about Antiarrhythmics. I was getting conflicting answers from some of the medics.

In VF/tach if you get a pulse back after the first or second defibrillation, prior to antiarrhythmics .....are they still given once pulses return? Like an infusion or a drip to prevent them from going back into the arrhythmia?

Or does induced hypothermia take the place of the amiodarone infusion and drip once ROSC is achieved? Or are they given during induced hypothermia?

:blink::unsure:

The hypothermia is really a form of neuroprotection, and can only be undertaken if the patient is hemodynamically, and electrically, stable.

As for post-ROSC antiarrhythmics, it's funny you should ask. We often give lidocaine or whatever after we've achieved ROSC, but there hasn't been much evidence to back that up. A recent study looked at patients who got lidocaine after getting pulses back, and found suggestive evidence that this prevents re-arrest. It's retrospective, so it isn't proof, but it's the best you're going to find so far.

If you want to read my "mini-review," it's at my FB page.

 

[Smash]

And my take on the whole post-resus thing is over here

 

[Aprz]

And my take on the whole post-resus thing is over here

Dammit Smash, you beat me to sharing your link. I have it bookmarked. It's like you're waiting for people to ask about anti arrhythmics, lol.

 

[HeatStroke]

From what I learned in ACLS, antidysrythmics like lido and amio are only given post ROSC if they were used to convert the patient.

Say, for example, I do a round of CPR, Defib, Epi, then the patient gets ROSC before the bolus of Amiodarone, no Amiodarone maintenance drip is indicated. That's according to the text though. I've heard different medics say they would consider it though possibly.

 

[Smash]

Dammit Smash, you beat me to sharing your link. I have it bookmarked. It's like you're waiting for people to ask about anti arrhythmics, lol.

If I had known, I would have never bothered; it took me ages to find that damn post!

 

[Aprz]

Honestly, I think it's one of the best read on the forum