Info

1-4 mg/min

Maximum rate 50 mg/min; Maximum dose 17 mg/kg

Bretylium*

5 mg/kg

10 mg/kg after 5 min

1-2 mg/min

See below*

*Removed from Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (22); currently unavailable in United States.

*Removed from Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (22); currently unavailable in United States.

and attempts at correction of potential causes—or if there is initial conversion but repeated reinitiation of the VTA. For persistent pulseless VTA, the recent recommendations classify antiarrhythmic drugs as either class IIB (unproven, but acceptable, possibly helpful) or indeterminate agents (22). The recommended drugs are amiodarone, lido-caine, magnesium (for torsades de pointes or refractory VF), and procainamide (see Table 1). Notably, bretylium has been removed from these most recent guidelines because of its high rate of adverse effects, the availability of other agents with a more favorable intended/adverse effect profile, and lack of availability of bretylium from the manufacturer. For persistent VTA, defibrillation shocks are given after administration of each dose of the antiarrhythmic drug. After return of spontaneous circulation, patients are generally maintained initially on a continuous infusion of an antiarrhythmic drug; dosages are given in Table 1.

For treatment of the patient who presents with a VTA that is hemodynamically stable, AHA/ACLS recommendations are that the basic "ABC" (Airway, Breathing, Circulation: i.e., secure airway, administer oxygen, start iv, attach monitor) be followed by assessment of vital signs, review of history, physical examination, a 12-lead ECG, and a portable chest X-ray. Although lidocaine had traditionally been used first in previous ACLS algorithms in the United States, it appears less effective in VT not caused by acute ischemia or infarction. In a randomized study, Goergels et al. found iv procainamide more likely than lidocaine to terminate monomorphic VT in the non-AMI setting (24). The most recent guidelines do not recommend lidocaine initially in all VT patients. Rather, antiarrhythmic drug recommendations in these guidelines are based on cardiac function (22). For patients with normal cardiac function, procainamide and sotalol are recommended as initial agents, with amiodarone and lidocaine also listed as acceptable options. Intravenous sotalol is not approved for use in the United

Table l

Antiarrhythmic Drug Dosing for Hemodynamically Tolerated VT

Table l

Antiarrhythmic Drug Dosing for Hemodynamically Tolerated VT

Drug

Bolus

Rebolus

Infusion

Comments

Procainamide

20-50 mg/min

Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

Get My Free Ebook


Post a comment