Due to recent changes in the ALS PCS cardiac arrest medical directive and the OBHG companion document, the education team at SWORBHP would like to review amiodarone administration in the setting of medical cardiac arrest.

When can you give amiodarone? 

Amiodarone is indicated for VF or pulseless VT (pVT) that is refractory to defibrillation.

What does “refractory to defibrillation” mean? 

Following the second analyze & defibrillation OR following a shock if the patient had been previously defibrillated.

Questions and Answers

Question: My patient is undergoing multiple rhythm changes. From VF to PEA back to VF. Can I still administer amiodarone?

Answer: Yes. Amiodarone is indicated for VF/pVT that is refractory to defibrillation. You must ensure that the patient still meets the condition of VF OR pVT in the analysis prior to administration.


Question: My patient is in refractory VF. Do I wait until I have maxed out my amiodarone protocol to transport?

Answer: No. Amiodarone would be indicated in VF/pVT that is refractory to defibrillation. However, transport should occur after the 3rd epinephrine or per study protocol timing.


Question: My service is utilizing dual sequential external defibrillation. Do I still administer amiodarone?

Answer: Yes. As long as the conditions are met in the directive, amiodarone is still indicated.


Question: Is Torsades de Pointes a contraindication for amiodarone administration?

Answer: No. Acute treatment with amiodarone does not have the QT-interval increasing effects that long term use does. It is safe to use as indicated in the directive.

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