Editing Cardiac arrest (section)

=== Additional medications ===

[[Sodium bicarbonate|Bicarbonate]], given as sodium bicarbonate, works to stabilize [[Metabolic acidosis|acidosis]] and [[hyperkalemia]], both of which can contribute to and exacerbate cardiac arrest. If acid-base or electrolyte disturbance is evident, bicarbonate may be used. However, if there is little suspicion that these imbalances are occurring and contributing to the arrest, routine use of bicarbonate is not recommended as it does not provide additional benefit.<ref>{{cite journal | vauthors = Xu T, Wu C, Shen Q, Xu H, Huang H | title = The effect of sodium bicarbonate on OHCA patients: A systematic review and meta-analysis of RCT and propensity score studies | journal = The American Journal of Emergency Medicine | volume = 73 | pages = 40–46 | date = November 2023 | pmid = 37611525 | doi = 10.1016/j.ajem.2023.08.020 | s2cid = 260893519 }}</ref>

[[Calcium chloride|Calcium]], given as calcium chloride, works as an [[inotrope]] and [[vasopressor]]. Calcium is used in specific circumstances such as electrolyte disturbances (hyperkalemia) and [[Calcium channel blocker toxicity|calcium-channel blocker toxicity]]. Overall, calcium is not routinely used during cardiac arrest as it does not provide additional benefit (compared to non-use) and may even cause harm (poor neurologic outcomes).<ref>{{cite journal | vauthors = Messias Hirano Padrao E, Bustos B, Mahesh A, de Almeida Castro M, Randhawa R, John Dipollina C, Cardoso R, Grover P, Adler Maccagnan Pinheiro Besen B | display-authors = 6 | title = Calcium use during cardiac arrest: A systematic review | journal = Resuscitation Plus | volume = 12 | pages = 100315 | date = December 2022 | pmid = 36238582 | pmc = 9550532 | doi = 10.1016/j.resplu.2022.100315 }}</ref>

[[Vasopressin]] overall does not improve or worsen outcomes compared to epinephrine.<ref name="Neumar-2015" /> The combination of epinephrine, vasopressin, and [[methylprednisolone]] appears to improve outcomes.<ref>{{cite journal | vauthors = Belletti A, Benedetto U, Putzu A, Martino EA, Biondi-Zoccai G, Angelini GD, Zangrillo A, Landoni G | display-authors = 6 | title = Vasopressors During Cardiopulmonary Resuscitation. A Network Meta-Analysis of Randomized Trials | journal = Critical Care Medicine | volume = 46 | issue = 5 | pages = e443–e451 | date = May 2018 | pmid = 29652719 | doi = 10.1097/CCM.0000000000003049 | url = https://www.zora.uzh.ch/id/eprint/162689/1/document%282%29.pdf | url-status = live | s2cid = 4851288 | archive-date = 5 March 2020 | archive-url = https://web.archive.org/web/20200305002245/https://www.zora.uzh.ch/id/eprint/162689/1/document%282%29.pdf | hdl = 1983/d002beb9-1298-4134-b062-c617f3df43f2 }}</ref> 

The use of atropine, lidocaine, and amiodarone have not been shown to improve survival from cardiac arrest.<ref>{{cite journal | vauthors = McLeod SL, Brignardello-Petersen R, Worster A, You J, Iansavichene A, Guyatt G, Cheskes S | title = Comparative effectiveness of antiarrhythmics for out-of-hospital cardiac arrest: A systematic review and network meta-analysis | journal = Resuscitation | volume = 121 | pages = 90–97 | date = December 2017 | pmid = 29037886 | doi = 10.1016/j.resuscitation.2017.10.012 }}</ref><ref>{{cite journal | vauthors = Ali MU, Fitzpatrick-Lewis D, Kenny M, Raina P, Atkins DL, Soar J, Nolan J, Ristagno G, Sherifali D | display-authors = 6 | title = Effectiveness of antiarrhythmic drugs for shockable cardiac arrest: A systematic review | journal = Resuscitation | volume = 132 | pages = 63–72 | date = November 2018 | pmid = 30179691 | doi = 10.1016/j.resuscitation.2018.08.025 | url = http://wrap.warwick.ac.uk/113491/1/WRAP-effectiveness-antiarrhythmic-drugs-cardiac-review-Nolan-2018.pdf | url-status = live | s2cid = 52154562 | archive-url = https://web.archive.org/web/20200305122730/http://wrap.warwick.ac.uk/113491/1/WRAP-effectiveness-antiarrhythmic-drugs-cardiac-review-Nolan-2018.pdf | archive-date = 5 March 2020 }}</ref><ref name="Wang-2017" />

Atropine is used for symptomatic [[bradycardia]]. It is given at a dose of 1&nbsp;mg (iv), and additional 1&nbsp;mg (iv) doses can be given every 3–5 minutes for a total of 3&nbsp;mg. However, the 2010 guidelines from the American Heart Association removed the recommendation for atropine use in pulseless electrical activity and asystole for lack of evidence supporting its use.<ref>{{cite journal | vauthors = Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ | display-authors = 6 | title = Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | journal = Circulation | volume = 122 | issue = 18 Suppl 3 | pages = S729–S767 | date = November 2010 | pmid = 20956224 | doi = 10.1161/CIRCULATIONAHA.110.970988 | doi-access = free }}</ref><ref name="Wang-2017" />