In VF/pulseless VT arrest, the administration of drugs should not delay DC shocks. Defibrillation is still the only intervention capable of restoring a spontaneous circulation. In EMD or PEA (pulseless electrical activity), the search for specific and correctable causes (4 Hs and 4 Ts) is of prime importance. If no evidence exists for any specific cause CPR should be continued, with the use of adrenaline every 3–5 min.

Adrenaline (epinephrine) 1 mg (10 ml 1 in 10 000/1 ml 1 in 1000)

Adrenaline has both alpha and beta effects. The alpha effect increases perfusion pressure and thus myocardial and cerebral blood flow. The beta-1 effect helps to maintain cardiac output after spontaneous heart action has been restored.

1. • VF/VT

When treating VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock and then every 3–5 min (during alternate cycles of CPR).

1. • PEA/asystole

Give adrenaline 1 mg IV as soon as IV access is achieved and repeat every 3–5 min.

Amiodarone 300 mg IV

If VF/VT persists after the third shock, give amiodarone 300 mg as an IV bolus. A further 150 mg may be given for recurrent or refractory VF/VT, followed by an IV infusion of 900 mg over 24 h.