Adjunctive Therapeutics in the Management of Cardiopulmonary Resuscitation: A Narrative Literature Review

• Published in: Journal of clinical medicine Vol. 12; no. 23; p. 7374
• Main Authors: Hoffer, Megan, Pena, Robert C F, Tran, Quincy K, Pourmand, Ali
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 28-11-2023
• Subjects: Acidosis; Adjuvants, Pharmaceutic; Carbonates; Cardiac arrest; Cardiac arrhythmia; Cardiopulmonary resuscitation; Care and treatment; Case reports; Clinical trials; CPR; CPR (First aid); Electrolytes; Emergency medical care; Epinephrine; Hyperkalemia; Hypocalcemia; Medical research; Medicine, Experimental; Methods; Mortality; Patients; Shock; Sodium; Sodium bicarbonate; Tachycardia; United States; magnesium; cardiopulmonary resuscitation; steroids; calcium; cardiac arrest; sodium bicarbonate
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12237374

Nearly 565,000 patients will suffer from prehospital and inpatient cardiac arrest in the United States per annum. Cardiopulmonary resuscitation and all associated interventions used to achieve it remain an essential focus of emergency medicine. Current ACLS guidelines give clear instructions regarding mainstay medications such as epinephrine and antiarrhythmics; however, the literature remains somewhat controversial regarding the application of adjunctive therapeutics such as calcium, magnesium, sodium bicarbonate, and corticosteroids. The available data acquired in this field over the past three decades offer mixed pictures for each of these medications on the effects of core metrics of cardiopulmonary resuscitation (e.g., rate of return of spontaneous circulation, survival-to-hospitalization and discharge, 24 h and 30 d mortality, neurological outcome), as well as case-specific applications for each of these interventions (e.g., polymorphic ventricular tachycardia, electrolyte derangements, acidosis, post-arrest shock). This narrative literature review provides a comprehensive summary of current guidelines and published data available for these four agents and their use in clinical practice.