During an in-hospital cardiac arrest from shockable rhythm (VF), after two defibrillation attempts and 2 minutes of CPR have been performed, adrenaline has been given. What is the NEXT antiarrhythmic drug recommended in the AHA ACLS algorithm?
- A Lidocaine 100 mg IV
- B Magnesium sulphate 2 g IV
- C Amiodarone 300 mg IV ✓
- D Procainamide 500 mg IV over 30 minutes
Correct answer: C. Amiodarone 300 mg IV
Explanation
In the AHA 2020 ACLS algorithm for shock-refractory VF/pVT, after the 3rd defibrillation attempt (following 2 shocks and 2 minutes of CPR with the first dose of adrenaline 1 mg IV), amiodarone 300 mg IV is the first-line antiarrhythmic. If VF persists, a second dose of amiodarone 150 mg IV may be given before or after the 5th shock. Lidocaine (1–1.5 mg/kg IV) is an alternative when amiodarone is unavailable. Magnesium 2 g IV is specifically indicated for polymorphic VT (torsades de pointes) associated with hypomagnesaemia or prolonged QT, not routine VF.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.