CHANGES IN THE PHARMACOTHERAPY OF CPR

The objective of this study was to review current changes in the pharm acologic management of cardiac arrest (ventricular fibrillation, pulse less ventricular tachycardia, asystole, and electromechanical dissocia tion) as put fourth by the American Heart Association's 1992 Guideline s for Cardiopulmonary Resuscitation and Emergency Cardiac Care. We con cluded that the 1992 Guidelines provide a reference base for all clini cians involved in emergency cardiac care. The newly revised recommenda tions are classified on the basis of the true clinical merit of the in tervention, for example, an intervention that has been proved effectiv e (i.e., high-dose epinephrine) versus one that is possibly effective (i.e., high-dose epinephrine). The preferred intravenous fluid to be u sed in resuscitation is saline solution or lactated ringers solution b ecause of possible adverse neurologic outcomes seen with dextrose-cont aining fluids. The dose of all drugs administered via the endotracheal route should be 2 to 2.5 times the intravenous dose. Modifications in the dose or dosing interval have been recommended for epinephrine, at ropine, lidocaine, bretylium, and procainamide during cardiopulmonary resuscitation. Options for high-dose epinephrine therapy are offered, but neither recommended or discouraged. Magnesium sulfate has been add ed for the management of torsades de points, severe hypomagnesemia, or refractory ventricular fibrillation. The maximum total dose of atropi ne in the treatment of asystole and electromechanical dissociation has been increased from 2 mg to 0.04 mg/kg. The use of sodium bicarbonate should be limited to the treatment of hyperkalemia, tricyclic antidep ressant overdose, overdoses requiring urinary alkalinization, or preex isting bicarbonate sensitive acidosis.