Meds to Avoid Intra-Arrest

In this podcast episode, Dr. Colin McCloskey, an EM Intensivist at University Hospitals, delves into the topic of medications to avoid during intra-arrest situations. He highlights that there are only three interventions that truly improve cardiac arrest outcomes: early defibrillation, high-quality CPR, and eCPR. The podcast discusses the limitations of certain medications commonly used during cardiac arrests. Calcium, despite its potential as a vasopressor, doesn't improve outcomes when administered empirically, even for hyperkalemia-related arrests. Sodium bicarbonate, intended to counter metabolic acidosis, proves ineffective in improving the return of spontaneous circulation (ROSC) or neuro-intact survival. Similarly, the use of lytics, even in cases of unstable coronary artery disease, doesn't significantly impact ROSC or neuro outcomes. The episode emphasizes the importance of focusing on the three interventions that have been shown to make a difference: high-quality CPR, timely defibrillation, and eCPR if available.

Takeaway Points:

1. Only three interventions have demonstrated improved cardiac arrest outcomes: early defibrillation, high-quality CPR, and eCPR.
2. Calcium's potential as a vasopressor doesn't translate into improved outcomes when used empirically during cardiac arrests, even for hyperkalemia cases.
3. Sodium bicarbonate fails to enhance ROSC or neuro-intact survival, and it's only effective for specific cases like sodium channel pathology.
4. The use of lytics, even with unstable coronary artery disease, doesn't yield significant improvements in ROSC or neuro outcomes during cardiac arrest.
5. The podcast underscores the significance of prioritizing high-quality CPR, defibrillation for shockable rhythms, and potentially eCPR for maximizing neuro-intact survival during intra-arrest situations.