What is the first-line vasopressor in ACLS for cardiac arrest and its dosing?

What is the first-line vasopressor in ACLS for cardiac arrest and its dosing?

• A. Epinephrine 1 mg IV/IO every 3-5 minutes
• B. Norepinephrine 1 mg IV
• C. Dopamine 5-10 mcg/kg/min
• D. Phenylephrine 100 mcg IV

Answer: (A)

During cardiac arrest, the goal is to maximize perfusion to the heart and brain while CPR is ongoing. Epinephrine works best for this because its alpha-adrenergic effects cause peripheral vasoconstriction, raising systemic vascular resistance and diastolic aortic pressure, which increases coronary and cerebral perfusion pressures during CPR. The beta-adrenergic actions can provide some cardiac support, but the critical benefit in arrest comes from improving perfusion pressures through constriction. For this reason, the recommended first-line vasopressor is given intravenously or via intraosseous access at 1 mg every 3-5 minutes during CPR. If IV/IO access isn’t available, intraosseous access is a suitable alternative. Other vasopressors can raise blood pressure, but they don’t improve coronary perfusion during CPR as effectively, or they increase afterload and oxygen demand in ways that are less advantageous in this setting.

During cardiac arrest, the goal is to maximize perfusion to the heart and brain while CPR is ongoing. Epinephrine works best for this because its alpha-adrenergic effects cause peripheral vasoconstriction, raising systemic vascular resistance and diastolic aortic pressure, which increases coronary and cerebral perfusion pressures during CPR. The beta-adrenergic actions can provide some cardiac support, but the critical benefit in arrest comes from improving perfusion pressures through constriction. For this reason, the recommended first-line vasopressor is given intravenously or via intraosseous access at 1 mg every 3-5 minutes during CPR. If IV/IO access isn’t available, intraosseous access is a suitable alternative. Other vasopressors can raise blood pressure, but they don’t improve coronary perfusion during CPR as effectively, or they increase afterload and oxygen demand in ways that are less advantageous in this setting.