Cardiorespiratory arrest and post-arrest care — branching viva

Branch 1 — Non-shockable arrest

Examiner. The monitor shows asystole. What drug do you give, and when? ^[2]

The ERC gives adrenaline 10 µg/kg IV/IO (maximum 1 mg) as soon as possible, followed by a flush, and repeats it every 4 minutes. The AHA considers it reasonable to give the first epinephrine dose as early as possible, and may repeat it every 3 to 5 minutes until ROSC. ^{[2] [1]}

Examiner. What is the evidence for early epinephrine? ^[11]

An ILCOR systematic review found 7 observational studies and no randomised trials. Earlier first epinephrine was favourable in both in-hospital and out-of-hospital arrest, but the optimal interval was unclear. ^[11]