From the Guidelines
The recommended first IV dose of amiodarone for a patient with refractory ventricular fibrillation is 300 mg administered as a rapid bolus, as supported by the most recent and highest quality study 1. This initial dose should be diluted in 20-30 mL of dextrose 5% in water (D5W) or normal saline and administered over a short period, typically less than 10 minutes. After the initial bolus, if ventricular fibrillation persists, a second dose of 150 mg can be considered, as suggested by both 1 and 1. The maximum cumulative dose should not exceed 2.2 g over 24 hours. When administering amiodarone, healthcare providers should be aware of potential hypotension due to the vasodilatory effects of the medication and its solvents, as noted in 1. Some key points to consider when using amiodarone include:
- Amiodarone affects sodium, potassium, and calcium channels and has alpha and beta-adrenergic blocking properties, as described in 1
- It can be considered for treatment of VF or pulseless VT unresponsive to shock delivery, CPR, and a vasopressor, as recommended in 1
- Continuous cardiac monitoring is essential during and after administration, as the medication can cause bradycardia and hypotension, as reported in 1
- Amiodarone works by prolonging the action potential and refractory period in myocardial tissue, blocking sodium, potassium, and calcium channels, as well as alpha and beta-adrenergic receptors, which helps terminate and prevent recurrence of ventricular arrhythmias, as explained in 1.
From the Research
Recommended First IV Dose of Amiodarone
- The recommended first IV dose of amiodarone for a patient with refractory ventricular fibrillation is 300 mg, as mentioned in the study 2.
- This dose is administered intravenously, and it is part of the treatment protocol for refractory ventricular fibrillation, which is defined as a pulseless ventricular arrhythmia that persists despite standard defibrillation attempts and administration of epinephrine.
Treatment Protocol
- The treatment protocol for refractory ventricular fibrillation involves the administration of amiodarone 300 mg intravenously, followed by three 1-mg intravenous doses of epinephrine, as described in the study 2.
- The use of amiodarone in the treatment of refractory ventricular fibrillation is supported by studies such as 3, which compared amiodarone with lidocaine in patients with out-of-hospital cardiac arrest and found that amiodarone led to higher rates of survival to hospital admission.
Comparison with Lidocaine
- Studies such as 4 and 5 have compared the effectiveness of amiodarone and lidocaine in the treatment of ventricular fibrillation and pulseless ventricular tachycardia, with mixed results.
- While some studies have found no significant difference in survival rates between amiodarone and lidocaine, others have found that lidocaine may be associated with higher rates of return of spontaneous circulation and survival to hospital discharge, as reported in the study 5.