What is the recommended dose of amiodarone (anti-arrhythmic medication) for pediatric cardiac arrest?

Amiodarone Dosing for Pediatric Cardiac Arrest

For pediatric cardiac arrest, amiodarone should be administered at a dose of 5 mg/kg as an intravenous (IV) or intraosseous (IO) bolus, which can be repeated up to 2 times for refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), with a maximum total dose of 15 mg/kg. 1, 2

Indications and Administration

• Amiodarone is indicated specifically for shock-refractory VF or pVT in pediatric cardiac arrest
• Administration sequence:
  1. Begin high-quality CPR
  2. Deliver initial defibrillation for shockable rhythms
  3. Administer epinephrine (0.01 mg/kg)
  4. For persistent VF/pVT, administer amiodarone 5 mg/kg IV/IO bolus
  5. May repeat amiodarone up to 2 additional times (total of 3 doses) if VF/pVT persists 2

Evidence and Guidelines

The American Heart Association (AHA) guidelines consistently recommend the 5 mg/kg IV/IO bolus dose of amiodarone for pediatric cardiac arrest. The 2020 AHA guidelines specifically state that amiodarone may be repeated up to 3 total doses for refractory VF or pVT 2, while the 2010 guidelines mentioned repeating up to 2 times 2. The most recent guidance from 2025 confirms the 5 mg/kg dose with repetition up to 2 times (maximum total 15 mg/kg) 1.

Monitoring and Precautions

• Continuous cardiac monitoring is essential during and after amiodarone administration
• Monitor for potential adverse effects:
  • Hypotension (may require dose adjustment)
  • Bradycardia
  • QT interval prolongation 1

Clinical Efficacy

While amiodarone is recommended in current guidelines, it's important to note that observational research has shown mixed results regarding its efficacy compared to alternatives like lidocaine. A 2014 study found that lidocaine was associated with improved return of spontaneous circulation (ROSC) and 24-hour survival, while amiodarone showed no such association 3. However, a more recent 2020 matched cohort study found no significant differences in outcomes between lidocaine and amiodarone 4.

Key Points for Implementation

• Administer amiodarone only after initial defibrillation attempts and epinephrine have failed
• Ensure minimal interruptions to chest compressions during drug administration
• Be prepared to manage potential hypotension following administration
• Continue high-quality CPR throughout resuscitation efforts

The recommendation for amiodarone at 5 mg/kg IV/IO for pediatric cardiac arrest represents the current standard of care based on AHA guidelines, despite limited evidence showing superiority over other antiarrhythmics like lidocaine.