The 2020 ACLS guidelines provide recommendations on the medication-specific management for arrhythmias including wide-complex tachycardia, regular narrow-complex tachycardia, atrial fibrillation/flutter, and bradycardia [1]. There are also our 2020 ACLS guideline summaries on vasopressor and non-vasopressor medications used during cardiac arrest and toxicology-related conditions.
Wide-complex tachycardia (WCT)
| Wide-complex tachycardia | Medication(s) | Evidence |
|---|---|---|
| Hemodynamically stable | Adenosine | COR 2b, LOE B-NR |
| Amiodarone, procainamide, or sotalol | COR 2b, LOE B-R | |
| NOTE: Verapamil is harmful | COR 3, LOE B-NR | |
| Polymorphic VT with long QT (torsades de points) | Magnesium | COR 2b, LOE C-LD |
| Polymorphic VT without long QT | Lidocaine or amiodarone | COR 2b, LOE C-LD |
Regular narrow-complex tachycardia
- Vagal maneuvers (COR 1, LOE B-R)
- Adenosine (COR 1, LOE B-R)
- Diltiazem or verapamil (COR 2a, LOE B-R)
- Beta-blockers (COR 2a, LOE C-LD)
Atrial fibrillation/flutter with rapid ventricular rate
- Beta-blocker or diltiazem or verapamil (COR 1, LOE B-NR)
- Amiodarone (COR 2a, LOE B-NR)
Bradycardia
- Treat reversible causes (COE 1, LOE C-EO)
- Atropine if hemodynamic compromise (COR 2a, LOE B-NR)
- Epinephrine or transcutaneous pacing if unresponsive to atropine (COR 2b, LOE C-LD)
Reference
Panchal AR, Bartos JA, CabaƱas JG, et al; Adult Basic and Advanced Life Support Writing Group. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S366-S468. doi: 10.1161/CIR.0000000000000916. Epub 2020 Oct 21. PMID: 33081529.
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