During in-hospital cardiac arrest, high-quality CPR is being performed. After the third shock for ventricular fibrillation, which drug combination is recommended simultaneously with CPR continuation?

• A Adrenaline 1 mg IV + lidocaine 100 mg IV
• B Vasopressin 40 units IV + amiodarone 150 mg IV
• C Adrenaline 1 mg IV + sodium bicarbonate 50 mEq IV
• D Adrenaline 1 mg IV + amiodarone 300 mg IV ✓

Explanation

Per AHA ACLS 2020 guidelines for shock-refractory VF/pulseless VT, adrenaline (epinephrine) 1 mg IV is given every 3–5 minutes, and amiodarone 300 mg IV bolus is given after the third defibrillation attempt (first antiarrhythmic dose). A second dose of amiodarone 150 mg may be given after the fifth shock. Vasopressin was removed from ACLS algorithms in 2015 updates as it offers no benefit over adrenaline. Sodium bicarbonate is not recommended routinely during cardiac arrest and is reserved for specific conditions (hyperkalaemia, tricyclic toxicity).

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.