What is the dosing of Amiodarone (amiodarone) for pulseless Ventricular Tachycardia (VT) in Advanced Cardiovascular Life Support (ACLS)?

From the Guidelines

For pulseless VTach in ACLS, administer amiodarone 300 mg IV/IO as the first dose, followed by a second dose of 150 mg IV/IO if needed, as recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. This dosing regimen is based on the study that showed improved hospital admission rates when amiodarone was administered to adults with refractory VF/pulseless VT in the out-of-hospital setting 1. Key points to consider when administering amiodarone include:

• Amiodarone can be considered for treatment of VF or pulseless VT unresponsive to shock delivery, CPR, and a vasopressor 1
• The medication works by affecting sodium, potassium, and calcium channels and has beta-adrenergic blocking properties 1
• Administration of amiodarone should be followed by a 20 mL saline flush and elevation of the extremity to minimize adverse effects
• Be aware that amiodarone can cause hypotension, especially with rapid administration, and may prolong the QT interval 1
• If amiodarone is unavailable, alternative medications such as lidocaine may be considered, but the primary recommendation is to use amiodarone due to its proven efficacy in improving hospital admission rates 1

From the FDA Drug Label

The recommended starting dose of amiodarone is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: Initial Load: 150 mg in 100 mL (in D5W) infused over 10 minutes Followed by: 1 mg/min for 6 hours Followed by: 0.5 mg/min thereafter For breakthrough episodes of VF or hemodynamically unstable VT, repeat the Initial Load

The dosing for Amiodarone in ACLS pulses VTach is as follows:

• Initial Load: 150 mg in 100 mL (in D5W) infused over 10 minutes
• Followed by: 1 mg/min for 6 hours
• Followed by: 0.5 mg/min thereafter
• For breakthrough episodes of VF or hemodynamically unstable VT, repeat the Initial Load 2, 2

From the Research

ACLS Pulseless VTach Amiodarone Dosing

• The optimal antiarrhythmic drug therapy, including amiodarone, in the treatment of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) cardiac arrest that is refractory to defibrillation is uncertain 3.
• A large randomized controlled trial compared amiodarone, lidocaine, and saline 0.9% sodium chloride for the treatment of refractory VF/pVT out-of-hospital cardiac arrest and reported no difference in survival to hospital discharge or neurological outcome 3.
• In patients with witnessed arrest, survival was improved with antiarrhythmic drugs compared to saline 3.
• The benefit of antiarrhythmic drugs appears to be for those patients in whom initial early CPR and defibrillation attempts fail and the antiarrhythmic drug is given early 3.
• There does not appear to be any clear survival benefit for any one particular drug, and other factors such as availability and cost should be considered when deciding which drug to use 3.
• The diagnosis of ventricular tachycardia (VT) is usually made based on electrocardiographic data, most commonly 12-lead echocardiography (ECG), as well as supportive cardiac telemetric monitoring 4.
• Distinguishing between VT and supraventricular arrhythmias on ECG can be difficult, but the VT diagnosis frequently needs to be made rapidly in the acute setting 4.
• However, there is no specific information on amiodarone dosing for pulseless VTach in the provided studies.