Amiodarone and ACLS
Amiodarone and ACLS
Amiodarone is considered a class III antiarrhythmic agent and is used for various types tachyarrhythmias. Because of its associated toxicity and serious side-effects it should be used cautiously and care should be taken to ensure that cumulative doses are not exceeded.
Indications for ACLS
Amiodarone is an antiarrhythmic that is used to treat both supraventricular arrhythmias and ventricular arrhythmias.
The mechanism of action of amiodarone remains unknown, but within the framework of ACLS, amiodarone is used primarily to treat ventricular fibrillation and ventricular tachycardia that occurs during cardiac arrest and is unresponsive to shock delivery, CPR, and vasopressors.
Amiodarone should not be used in individuals with polymorphic VT as it associated with a prolonged QT interval which is made worse with antiarrhythmic drugs.
Amiodarone should only be used after defibrillation/cardioversion and first line drugs such as epinephrine and vasopressin have failed to convert VT/VF.
Route
Amiodarone can be administered by intravenous or intraosseous route.
Dosing
The maximum cumulative dose in a 24 hour period should not exceed 2.2 grams.
Within the VT/VF pulseless arrest algorithm, the dosing is as follows:
300mg IV/IO push → (if no conversion) 150 mg IV/IO push → (after conversion) Infusion #1 360 mg IV over 6 hours (1mg/min) → Infusion #2 540 mg IV over 18 hours (0.5mg/min)
For tachyarrhythmias other than life threatening, expert consultation should be considered before use.
For Tachycardia other than pulseless VT/VF, Amiodarone dosing is as follows: (see above note)
150 mg over 10 minutes → repeat as needed if VT recurs → maintenance infusion of 1mg/min for 6 hours
If you convert with the first 300, do you then hang the 1mg/min dose?
As soon as possible during the post arrest phase.
Does Amiodarone still need to be diluted in 25-30 cc’s of D5W or Normal saline ? Thanks!
Amiodarone should be diluted with D5W not normal saline. —Jeff
If amiodarone is given in the feild for cardiac arrest at a dose of 300mg and pt arrived to the ER and 30-40 min pass from time of transfer to further treatment in the ER is that dose count if pt continues to have vt or v-fib or can we give another 300mg dose and start from that time line? or count the 300mg dose and give 150mg ?
I believe that you would stick with the algorithm, give the 150mg and then start an infusion if needed. —Jeff
For ventricular irritability… multifocal PVCs, runs of VT, is lidocaine vs amiodarone a perscribers preference or is one better than the other? I am seeing both used… Seems to change back and forth, both have concerning side effects. Thanks!
In my experience, I have seen a much wider use of amiodarone for ventricular irritability. (over the past 5 years). As you state, it is not without its side effects. I think if I were a physician, I would pick amiodarone because it works amazingly well for decreasing ventricular arrhythmias and stabilizing an irritable heart.
I would not want to use it for more time than the ACLS guidelines call for due to its side effects.
Is Amiodarone only given for two doses for pulseless VT/VF? Initially 300 mg IV push and if no conversion, then 150 mg IV push? What happens if after the 150 mg IV push there is still no change in rhythm? Can you give one more dose of Amiodarone? Sorry for all these questions. Thanks!
If the two doses of amiodarone do not work the drug is finished and there are no repeat doses. It it works and converts, you will started an amiodarone infusion per protocol. In my experience, if it is going to work, it will usually convert with the first dose. However, studies have shown that the 2nd dose has a high enough conversion rate to justify it in the algorithm.—Jeff
All dead full dose 300mg. Half dead (still have a pulse), half the dose 150mg.
First drug for dead people Epi.
In cardiac arrest algorithm, how fast is Amiodarone given? I just took a pre-test for my ACLS class that said to give 300mg IV over 2 minutes – I specifically asked the instructor ans she said the guidelines say to giver over 2 minutes but the info above says to give IV push?? Please give me the correct answer Thanks
The 300 mg that is given in pulseless rhythms is given IV Push over a couple of seconds (as fast as you can push it in. The patient is dead, so it won’t hurt their ventricular activity! The 150mg dose is given for rhythms with a pulse, and therefore is given slower, over 10 minutes, which would be 15mg/min. When a patient has a pulse (ventricular activity), if you give amiodarone to fast, there is a risk of reducing cardiac output by suppressing ventricular muscular contraction.
You can look at page 165 in the AHA provider manual and it says under Amiodarone. For Cardiac Arrest the first dose is give IV push and if needed a second dose can be given IV push.
Hope this helps. Jeff