Pharmacotherapy Considerations for Inpatient Advanced Cardiac Life Support

Cardiac arrest, defined as the cessation of cardiac mechanical activity and confirmed by the absence of signs of circulation, is arguably the most serious emergency in the field of medicine.¹ Despite significant research, survival to hospital discharge remains at 9.1% for patients with out-of-hospital cardiac arrest; the survival rate is slightly higher at 18.8% for patients with in-hospital cardiac arrest.¹ Survival with good functional status at hospital discharge is even lower, at 7.1% for patients with out-of-hospital cardiac arrest and 12.9% for patients with in-hospital cardiac arrest.¹ Factors thought to contribute to this notable difference in survival rates include cause of the arrest, time to initiation of basic life support, and increased availability of treatment modalities and personnel for patients with in-hospital cardiac arrest.²

High-quality cardiopulmonary resuscitation and early defibrillation of shockable rhythms are the most effective interventions for improving survival rates and long-term clinical outcomes.³ Additional interventions, including establishing intravenous (IV) access for medication administration, should not delay or impede cardiopulmonary resuscitation or defibrillation. Nevertheless, medications remain a fundamental component of advanced cardiac life support (ACLS) and are the focus of this review.