Editing Cardiac arrest (section)

===Medications===
Medications recommended in the ACLS protocol include [[epinephrine]], [[amiodarone]], and [[lidocaine]].<ref name="Kronick-2015" /> The timing and administration of these medications depends on the underlying arrhythmia of the arrest.

Epinephrine acts on the alpha-1 receptor, which in turn increases the blood flow that supplies the heart.<ref>{{Cite web |title=Deep Dive into the Evidence: Epinephrine in Cardiac Arrest |url=http://www.emra.org/emresident/article/deep-dive-epi/ |access-date=2021-11-12 |website=www.emra.org |language=en}}</ref> Epinephrine in adults improves survival<ref>{{cite journal |vauthors=Vargas M, Buonanno P, Iacovazzo C, Servillo G |date=March 2019 |title=Epinephrine for out of hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials |journal=Resuscitation |volume=136 |pages=54–60 |doi=10.1016/j.resuscitation.2019.10.026 |pmid=30685547 |s2cid=207940828}}</ref> but does not appear to improve neurologically normal survival.<ref>{{cite journal |vauthors=Aves T, Chopra A, Patel M, Lin S |date=27 November 2019 |title=Epinephrine for Out-of-Hospital Cardiac Arrest: An Updated Systematic Review and Meta-Analysis. |journal=Critical Care Medicine |volume=48 |issue=2 |pages=225–229 |doi=10.1097/CCM.0000000000004130 |pmid=31789700 |s2cid=208537959}}</ref> In ventricular fibrillation and pulseless ventricular tachycardia, 1&nbsp;mg of epinephrine is given every 3–5 minutes, following an initial round of CPR and defibrillation.<ref name="Neumar-2015" /> Doses higher than 1&nbsp;mg of epinephrine are not recommended for routine use in cardiac arrest. If the person has a non-shockable rhythm, such as asystole, following an initial round of CPR, 1&nbsp;mg of epinephrine should be given every 3–5 minutes, with the goal of obtaining a shockable rhythm.<ref>{{cite journal | vauthors = Panchal AR, Berg KM, Hirsch KG, Kudenchuk PJ, Del Rios M, Cabañas JG, Link MS, Kurz MC, Chan PS, Morley PT, Hazinski MF, Donnino MW | display-authors = 6 | title = 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | journal = Circulation | volume = 140 | issue = 24 | pages = e881–e894 | date = December 2019 | pmid = 31722552 | doi = 10.1161/CIR.0000000000000732 | s2cid = 208019248 | doi-access = free }}</ref>

Amiodarone and lidocaine are anti-arrhythmic medications. Amiodarone is a [[class III antiarrhythmic]]. Amiodarone may be used in cases of [[ventricular fibrillation]], [[ventricular tachycardia]], and [[wide complex tachycardia]].<ref>{{cite book | vauthors = Florek JB, Lucas A, Girzadas D | chapter = Amiodarone |date=2024 | title = StatPearls | chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK482154/ |access-date=2024-01-31 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29489285 }}</ref> Lidocaine is a [[Class IB anti-arrhythmic]], also used to manage acute arrhythmias.<ref>{{cite book | vauthors = Beecham GB, Nessel TA, Goyal A | chapter = Lidocaine |date=2024 | title = StatPearls | chapter-url = http://www.ncbi.nlm.nih.gov/books/NBK539881/ |access-date=2024-01-31 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30969703 }}</ref> Anti-arrhythmic medications may be used after an unsuccessful defibrillation attempt. However, neither lidocaine nor amiodarone improves survival to hospital discharge, despite both equally improving survival to hospital admission.<ref>{{cite journal |vauthors=Sanfilippo F, Corredor C, Santonocito C, Panarello G, Arcadipane A, Ristagno G, Pellis T |date=October 2016 |title=Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis |journal=Resuscitation |volume=107 |pages=31–37 |doi=10.1016/j.resuscitation.2016.07.235 |pmid=27496262 |doi-access=free}}</ref> The first dose is given as a 300&nbsp;mg bolus. The second dose is given as a 600&nbsp;mg bolus.<ref name="Neumar-2015" />