From the Guidelines
In adult cardiac arrest with shock-refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), the initial amiodarone bolus should be 300 mg, with no specific reduction to 150 mg mentioned for any particular circumstance in the most recent guidelines. The administration of this bolus should be as a rapid intravenous (IV) push during ongoing CPR, immediately after a shock attempt, and followed by a 10 mL saline flush 1.
Key Considerations
- The standard initial dose of amiodarone remains 300 mg for all adult patients, regardless of weight, as per the most recent guidelines 1.
- A second dose of 150 mg amiodarone may be considered after 3-5 minutes if VF/pVT persists 1.
- Amiodarone works by blocking sodium, potassium, and calcium channels and has alpha and beta-adrenergic blocking properties, which helps stabilize the myocardium and potentially facilitates successful defibrillation 1.
- When administering amiodarone, healthcare providers should be aware of potential side effects including hypotension and bradycardia, though these are less concerning during cardiac arrest when circulation is already compromised 1.
Administration Details
- The medication should be readily available in crash carts and emergency response systems to avoid delays in administration during cardiac arrest scenarios.
- The recommended dose for amiodarone is unchanged, with randomized trials supporting an initial IV/IO dose of 300 mg with a second IV/IO dose of 150 mg if required 1.
Clinical Context
- The management of adult cardiac arrest with shock-refractory VF/pVT involves CPR, defibrillation, and the consideration of antiarrhythmic drugs like amiodarone or lidocaine 1.
- The optimal sequence of ACLS interventions for VF/pVT cardiac arrest, including administration of a vasopressor or antiarrhythmic drug, and the timing of medication administration in relation to shock delivery are not fully defined and may depend on various factors including the number of providers, their skill levels, and the ability to secure intravenous/intraosseous access in a timely manner 1.
From the FDA Drug Label
In the event of breakthrough episodes of VF or hemodynamically unstable VT, use 150 mg supplemental infusions of amiodarone (mixed in 100 mL of D5W and infused over 10 minutes to minimize the potential for hypotension)
The initial bolus of amiodarone is reduced to 150 mg in the event of breakthrough episodes of VF or hemodynamically unstable VT. This bolus should be administered over a period of 10 minutes to minimize the potential for hypotension, by mixing 150 mg of amiodarone in 100 mL of D5W 2.
From the Research
Administration of Amiodarone in Adult Cardiac Arrest
The administration of amiodarone in adult cardiac arrest with shock-refractory ventricular fibrillation (VF/pVT) is a critical aspect of treatment.
- The initial bolus of amiodarone is typically 300 mg, but there are specific circumstances under which this dose may be reduced to 150 mg 3.
- However, the provided studies do not specify the exact circumstances under which the initial bolus of amiodarone should be reduced from 300 mg to 150 mg.
- The time frame for administering the bolus is also not explicitly stated in the provided studies.
Considerations for Amiodarone Administration
When administering amiodarone, several factors should be considered, including:
- The patient's medical history and current condition
- The potential for adverse effects, such as those related to the drug's pharmacokinetics and electrophysiologic profile 3
- The availability and cost of alternative treatments, such as lidocaine 4, 5
- The potential benefits of other interventions, such as percutaneous coronary intervention and extra-corporeal CPR 6, 5
Evidence Limitations
The provided studies do not directly address the specific circumstances under which the initial bolus of amiodarone should be reduced from 300 mg to 150 mg or the time frame for administering the bolus.