Peri-arrest arrhythmias

The peri-arrest arrhythmias — bradycardias and tachycardias that threaten cardiac arrest — are managed from ANZCOR Guideline 11.9 (ILCOR-family adult ALS; ERC 2021 is the European sibling). Every load-bearing dose below is quoted from that guideline or from a trial abstract fetched this session. Circulating AHA “atropine 1 mg”, “magnesium 2 g as ANZCOR”, and invented cardioversion joule ladders are not ANZCOR 11.9.[1][4]

The stable-versus-unstable framework

The first assessment is for adverse features. For tachycardia ANZCOR lists systolic BP under 90 mmHg, heart rate > 150/min, chest pain, heart failure, or drowsiness or confusion. For bradycardia: systolic BP under 90 mmHg, heart rate under 40/min, ventricular arrhythmia, or heart failure. A pulseless patient leaves this algorithm and enters cardiac arrest care (Guideline 11.2).[1]

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1. [1]Australian and New Zealand Committee on Resuscitation Guideline 11.9 - Managing Acute Dysrhythmias ANZCOR, 2026.Source
2. [2]Australian and New Zealand Committee on Resuscitation Guideline 11.4 – Electrical Therapy for Adult Advanced Life Support ANZCOR, 2026.Source
3. [3]Australian and New Zealand Committee on Resuscitation Guideline 11.5 – Medications in Adult Cardiac Arrest ANZCOR, 2026.Source
4. [4]Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support Resuscitation, 2021.PMID 33773825
5. [5]Kudenchuk PJ, Cobb LA, Copass MK, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation N Engl J Med, 1999.PMID 10486418
6. [6]Dorian P, Cass D, Schwartz B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation N Engl J Med, 2002.PMID 11907287
7. [7]Ortiz M, Martín A, Arribas F, et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study Eur Heart J, 2017.PMID 27354046
8. [8]Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial Lancet, 2015.PMID 26314489
9. [9]Tzivoni D, Banai S, Schuger C, et al. Treatment of torsade de pointes with magnesium sulfate Circulation, 1988.PMID 3338130
10. [10]Long B, Koyfman A. Best Clinical Practice: Emergency Medicine Management of Stable Monomorphic Ventricular Tachycardia J Emerg Med, 2017.PMID 27751700
11. [11]Foerster CR, Andrew E, Smith K, et al. Amiodarone for sustained stable ventricular tachycardia in the prehospital setting Emerg Med Australas, 2018.PMID 30084131