Rational use of drugs for cardiac arrest and after cardiac resuscitation

In addition to the development of several new mechanical and electrical techniques, advances in the treatment of cardiac arrest in the last 2 decades include the better use of established drugs and the appearance of a few new pharmacologic agents as well. Drugs are used for various purposes in all stages of cardiac resuscitation: in the prevention of cardiac arrest, in the emergency restoration of circulation of oxygenated blood, in the restoration of intrinsic cardiac rhythm and in the prevention of recurrent attacks of arrest. Reflex vagal standstill is prevented by intravenous administration of atropine and careful ventilation. Depressed cardiac rhythmicity and conduction are treated with sympathomimetic amines that arouse, maintain and accelerate cardiac pacemakers. Epinephrine or isoproterenol is given intravenously, usually in diluted solution. The rapid onset and offset of action of the drugs given in this way permit moment to moment control and make for safety and efficacy in their use. Recurrent ventricular tachycardia or fibrillation and premonitory ectopic ventricular activity are treated with depressant drugs (lidocaine or procainamide) given intravenously in repeated doses, again for rapid, controlled and effective action.