A patient in the cardiac catheterisation lab develops VF during coronary angiography. After 3 defibrillation attempts and 3 rounds of CPR with adrenaline, VF persists. According to ACLS 2020 guidelines, which drug should be administered NEXT for shock-refractory VF?
- A IV Lignocaine 1.5 mg/kg as the preferred anti-arrhythmic in pulseless VF
- B IV Verapamil 5 mg to convert VF to a perfusing rhythm
- C IV Amiodarone 300 mg as first-line anti-arrhythmic for shock-refractory VF ✓
- D IV Magnesium 2 g only if QTc was prolonged pre-arrest
Correct answer: C. IV Amiodarone 300 mg as first-line anti-arrhythmic for shock-refractory VF
Explanation
2020 AHA/ACLS guidelines recommend amiodarone 300 mg IV bolus for shock-refractory VF/pulseless VT (after ≥3 defibrillations and adrenaline). A second dose of amiodarone 150 mg may be given for recurrent VF. Lidocaine (1–1.5 mg/kg) is an acceptable alternative when amiodarone is unavailable; both agents have Class IIb recommendation but amiodarone is the first-line anti-arrhythmic. Verapamil is absolutely contraindicated in VF/VT. Magnesium 2 g is specifically indicated for torsades de pointes (polymorphic VT with long QT), not routine VF.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.