ACLS and Amiodarone |


  1. Sherman says

    hi, can someone please explain what is ACLS guidelines for example like — 150 mg over 10 minutes
    Patient Care Record shows on 12/19/2022:
    911 call was made 12/19/2022 at 9:52AM
    Emergency responder’s arrived in 27 years old home at 9:58AM
    10:11 AM – Naloxone 2 Milligrams (mg)
    10:11 AM – Epinephrine 1 Milligrams (mg)
    10:13 AM – Heart rate pulse: 97
    10:15 AM – Epinephrine 1 Milligrams (mg)
    10:15 AM – Heart rate pulse: 100
    10:17 AM – Heart rate pulse: 102
    10:18 AM – Epinephrine 1 Milligrams (mg)
    10:18 AM – Heart rate pulse: 100
    10:19 AM – Patient response improved
    10:19 AM – Amiodarone 300 Milligrams (mg)
    10:22 AM – Heart rate pulse: 100
    10:24 AM – Amiodarone 150 Milligrams (mg)
    10:24 AM – Heart rate pulse: 94
    10:27 AM – Heart rate pulse: 84
    10:30 AM – Heart rate pulse: 48 (Death was Pronouncement 10:34AM)
    They estimmated his WEIGHT as 198.4 pounds but autopsy found he was 143 POUNDS
    however they administered 450 mg over 5 minutes in this case at 10:19 & 10:24AM

    • ACLS says

      The ending of this scenario with the patient developing bradycardia doesn’t make sense. He should’ve been treated with the bradycardia algorithm when his heart rate dropped to 48/min.

      Regarding amiodarone it is acceptable to get 2.2 grams in a 24 hour. There’s not much here to determine exactly what the cause of death was, but I think it’s unlikely that it was the amiodarone.

      Kind regards,

      • Rane says

        Jeff, I know that amiodarone is given for refractory vfib/pVT. Is there a disadvantage or poor pt outcome if amiodarone is given early, let’s say given after the first or second shock.

      • ACLS says

        The delay in administering amiodarone allows for these initial interventions to exert their effects. Administering amiodarone too early in the resuscitation process might preempt the potential benefits of simpler and more immediate interventions like defibrillation and epinephrine. While amiodarone improves the rate of return of spontaneous circulation (ROSC), it has not been shown to improve long-term survival rates or neurological outcomes when compared to placebo. This supports a more conservative approach to its use, prioritizing it only after other first-line interventions have failed.
        Kind regards,

  2. Many says

    According to the protocol of cardiac arrest with VF or VTp it’s recommander to defibrillate, give adrenalin, defibrilate again twice if the rythm still chocable and then to Give Amiodarone or Lidocaine.

    I want to know if Amiodarone can be administrated before adrenaline, if not Why or why adrenaline is given before Amiodarone.


    • ACLS says

      Epinephrine is administered before amiodarone during cardiac arrest because it helps to increase the heart rate and blood pressure which can improving blood flow to vital organs. This initial boost in circulation can enhance the chances of successful defibrillation and increase the likelihood of restoring a stable heart rhythm. Amiodarone, on the other hand, is an antiarrhythmic medication used to treat and prevent abnormal heart rhythms. It’s given after epinephrine to help stabilize the heart’s rhythm and prevent further arrhythmias.

    • Rane says

      Actually, the guideline for vfib/pVT is defibrillate, defibrillate, epi, defibrillate, amiodarone 300mg. Defibrillation is the recommended 1st line of treatment for vfib/pVT to reset the heart from its quivering motion. if it is refractory after 2 attempts. Epi is given every 3-5 mins. If still refractory after 3 attempts, amiodarone 300 mg is given. Why is epi given before amio? I dont know, I guess because amio is the last ditch effort for vfib/p/VT.

  3. Manuel says

    During Vfib or pVT when would you give the second amiodarone bolus? Right after the next CPR cycle (given the rythm is still the same) or do you have to wait three more shocks to administer the second bolus?
    And if after the second bolus the patient is still in Vfib or pVT can we give a third, fourth, and so on boluses until the maximum daily dose? Is there any evidence on that?
    Thank you in advance.

    • ACLS says

      The second bolus of amiodarone may be given after the 4the shock if it is needed for refractory VF or pVT. A third bolus of amiodarone is not recommended in the guidelines and this would be at the physicians discretion and with the 2.2 gram 24 hour maximum cumulative dose in mind.
      Kind regards, Jeff

  4. Zeinab Said says

    If patient received first dose Epinephrine for PEA and next cycle showed VF do we have to wait 3 shock to give amiodaron or can be given after the first shock ?

  5. Bridget says

    Hi Jeff, when a pt in VT is defibrillated and converts to PEA, should Amniodarone still be given, or does the algorithm shift to PEA and no anti arrhythmic is indicated?

    • ACLS says

      The algorithm would shift to the right branch and amiodarone would not be given unless the ventricular fibrillation reoccurred.
      Kind regards,

  6. A says

    Hi. May I know what is the normal cumulative dose of amiodarone? At what cumulative dose, it is considered to cause amiodarone pulmonary toxicity

  7. Adel says

    Is it necessary to dilute amiodarone before injection?
    And how much time dose it necessary to push 300mg amiodarone?10 min??
    Thank you

    • ACLS says

      During cardiac arrest amiodarone can be given in 10 mL of the diluent that is used to dilute it or undiluted if it is in the solution form from the vial.

      During cardiac arrest amiodarone is pushed the same way that Epinephrine is pushed (rapidly) and always followed by 20 mL of normal saline.

      Kind regards,

      • ACLS says

        Amiodarone should be diluted with D5W. However, normal saline can be used as a flush after Amiodarone administration. D5W is not necessary for the flush.

  8. Brittany says

    If the patient is in pulseless v tach and shocked three times and then regains a pulse but remains in v tach can Amiodarone 300 mg be administered or should only it be 150 mg or is it then up to the physicians discretion?

    • ACLS says

      To treat all acute tachyarrhythmias in adults, amiodarone can be given IV 150 mg over 10 minutes, followed by a 1 mg/min infusion for 6 hours, followed by an infusion at 0.5 mg/min. The recommended total dose over 24 hours should not exceed 2.4 grams.

      Kind regards,

  9. Kelly Gee says

    If ROSC is achieved and patient returns back to VFib arrest. Do we restart the amiodarone algorithm? Meaning do we give another initial dose of 300mg IVP.

    Thank you

    • ACLS says

      There is no clarity in the American Heart Association ACLS guidelines regarding this question. The maximum dose for a 24 hour period is 2.2 g of amiodarone and that would need to be maintained.

      The most likely option here would be for the physician running the code and the team to determine the best option. My guess would be they would probably start off where they had left during the initial code. A second option would be to start at the beginning using 300 mg, but I think this is unlikely.

      Kind regards,

  10. C says

    If a patient achieved ROSC after giving amiodarone 300mg bolus during vfib arrest and are now in a sinus rhythm, are there any situations where you would give a 150mg bolus x10 mins once ROSC is achieved and before starting the maintenance 1mg/min infusion?

    • ACLS says

      There would not be any situation where you would give the bolus unless the person was to go back into cardiac arrest. And as a matter of fact, he would not need to give the post arrest infusion unless there are continued arrhythmias during the post arrest phase.

      Kind regards,

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