2018 CPR update: AHA issues pediatric, adult recommendations

  • Jenny Blair, MD
  • Clinical Essentials
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  • For resuscitation of cardiac arrest with ventricular fibrillation (VF)/pulseless ventricular tachycardia (pVT), lidocaine is an option for a first-line treatment.  
  • Pediatric advanced life support (PALS) recommendations remain unchanged.

Why this matters

  • Improving survival after cardiac arrest remains a key public-health challenge. 


  • International Liaison Committee on Resuscitation second annual review of CPR literature.
  • 2018 American Heart Association (AHA) update regarding advanced cardiovascular life support: specifically, antiarrhythmic medications for adult and pediatric cardiac arrest and during return of spontaneous circulation (ROSC).

Key details

  • Adults with shock-refractory VF/pVT:
    • Authors suggest amiodarone or lidocaine, especially in witnessed arrest (weak recommendation, low-quality evidence [WR/LQE]).
    • They advise against routine magnesium (WR, very LQE).
    • Not enough evidence to make recommendations concerning bretylium, nifekalant, or sotalol, nor about antiarrhythmic prophylaxis during ROSC.
  • Consider magnesium for adults experiencing torsades de pointes (WR/LQE).
  • Adults with ROSC immediately after cardiac arrest:
    • Insufficient evidence to advise in favor of or against routine beta-blockade or lidocaine in first hour.
    • Consider prophylactic lidocaine if treatment of recurrent VF/pVT would be difficult, such as during transport (WR).
  • Infants and children with shock-refractory VF/pVT arrest: 
    • Authors suggest amiodarone or lidocaine (WR, very LQE based on 1 study; recommendation unchanged since 2015).

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