During in-hospital cardiac arrest in an adult with ventricular fibrillation, defibrillation fails after 3 shocks. According to ACLS 2020 guidelines, what is the correct dose of amiodarone?
- A 150 mg slow IV over 10 minutes
- B 5 mg/kg IV bolus
- C 300 mg IV bolus; second dose 150 mg if required ✓
- D 1 mg/kg IV bolus repeated every 5 minutes
Correct answer: C. 300 mg IV bolus; second dose 150 mg if required
Explanation
For shock-refractory VF/pVT in adults, AHA/ACLS 2020 recommends amiodarone 300 mg IV bolus after the third shock (given concurrently with the next CPR cycle, not during rhythm check). A second dose of 150 mg IV may be given if VF/pVT persists after subsequent shock. This is the same dosing protocol as previous guidelines. Lidocaine (1–1.5 mg/kg IV) is the alternative if amiodarone is unavailable. Amiodarone 150 mg over 10 minutes is the dose used for stable VT (not cardiac arrest).
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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