There are two types of medications that are mainly used for advanced cardiac life support. The second type is the antiarrhythmics that convert nonperfusing and hypoperfusing rhythms.
• Vasopressors
Vasopressors increases the blood perfusion to the brain and the heart making the return of spontaneous circulation more possible. This medication is usually administered after oxygen administration during a pulseless cardiac arrest. Epinephrine and vasopressin are the vasopressors that are recommended during advanced cardiac life support.
- Epinephrine is the most familiar vasopressor administered during cardiac arrest or any cardiac related emergency cases. This drug causes vasoconstriction and increased myocardial and cerebral blood flow during cardiopulmonary resuscitation. Epinephrine’s dose is 1mg IV in 1:10,000 solutions that is given every 3-5 minutes. A higher dose than that is not recommended.
- Vasopressin is the alternative medication for epinephrine if it is contraindicated or unavailable. Vasopressin’s dose is 40 units given thru IV and only given once. Vasopressin will rise the arterial blood pressure through nonadrenergic peripheral vasoconstriction.

• Antiarrhythmics
- For ventricular fibrillation or pulseless ventricular fibrillation, Amiodarone is the preferred medication. This drug affects the sodium, potassium anc calcium channels. Since this drug has many drug interactions, Amiodarone is administered carefully at the right dose which is 300mg thru IV push.If the ventricular fibrillation is not reversed, an additional dose of 150 mg thru intravenous infusion is done every 3-5 minutes.

- Lidocaine is popularly used in hospitals, it is also the alternative medication of choice when amiodarone is contraindicated or if it is unavailable. This drug action is decreasing the automaticity of the myocardium which then helps to reduce fibrillation which is very helpful to reverse an ischemic tissue. Initially, 1-1.5mg/kg is given thru intravenous infusion but if the arrhythmia does not reverse, 0.5-0.75mg/kg can be administered thru IV push at 5-10 minute intervals with a maximum dose of 3 mg/kg.
- Magnesium sulfate is another medication that is used for ventricular fibrillation or pulseless ventricular fibrillation especially when there are very low levels of magnesium (hypomagnesemia). Magnesium sulfate is given at a dose of 1-2g diluted in 10 ml D5W thru intravenous infusion and administered over 5-20 minutes.
- One reminder to always remember is that atropine is no longer recommended for asystole or Pulseless electrical activity since this drug actually does not have any therapeutic effect on whatsoever, this was updated last 2010 by the American heart association.
The American Heart Association has changed the CPR sequence from ABC (airway, breathing and circulation) to CAB (Compressions, Airway, and Breathing). For 40 years the sequence of ABC has been followed in which the top priority is opening and maintaining an open airway to allow the air to ventilate the victim’s lungs by doing the head tilt chin life maneuver. Second, the victim’s breathing is the next priority.
CPR training centers such as cpr williamson county offers advanced cardiac life support classes as well as classes for recertification that is necessary to meet everytwo years for rescuers.