p.13 抽出テキスト
October 21, 2025 Circulation. 2025;152(suppl 2):S538–S577. DOI: 10.1161/CIR.0000000000001376 S550 Wigginton et al Advanced Life Support: 2025 AHA Guidelines for CPR and ECC confounders, such as temporal trends, misclassification, and resuscitation characteristics.14 Further study is needed to evaluate the potential benefit of high-dose IM epinephrine in cardiac arrest. REFERENCES 1 Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, Regan S, Long J, Slowther A, Pocock H, et al; PARAMEDIC2 Collaborators. PARAMEDIC2 Collaborators. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2018;379:711–721. doi: 10.1056/NEJMoa1806842 2. Holmberg MJ, Fernando S, Elshaer A, Leong C, Drennan I; International Liaison Committee on Resuscitation Advanced Life Support Task. Vasopressors in adult cardiac arrest. Updated November 3, 2024. Accessed June 20, 2025. https://costr.ilcor.org/document/vasopressors-in-adult-cardiacarrest-als-3208-tf-sr 3. Zhong H, Yin Z, Kou B, Shen P, He G, Huang T, Liang J, Huang S, Huang J, Zhou M, et al. Therapeutic and adverse effects of adrenaline on patients who suffer out-of-hospital cardiac arrest: a systematic review and metaanalysis. Eur J Med Res. 2023;28:24. doi: 10.1186/s40001-022-00974-8 4. Ludwin K, Safiejko K, Smereka J, Nadolny K, Cyran M, Yakubtsevich R, Jaguszewski MJ, Filipiak KJ, Szarpak L, Rodríguez-Núñez A. Systematic review and meta-analysis appraising efficacy and safety of adrenaline for adult cardiopulmonary resuscitation. Cardiol J. 2021;28:279–292. doi: 10.5603/CJ.a2020.0133 5. Fernando SM, Mathew R, Sadeghirad B, Rochwerg B, Hibbert B, Munshi L, Fan E, Brodie D, Di Santo P, Tran A, et al. Epinephrine in Out-of- Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest. 2023;164:381–393. doi: 10.1016/j.chest.2023.01.033 6. Haywood KL, Ji C, Quinn T, Nolan JP, Deakin CD, Scomparin C, Lall R, Gates S, Long J, Regan S, et al. Long term outcomes of participants in the PARA- MEDIC2 randomised trial of adrenaline in out-of-hospital cardiac arrest. Resuscitation. 2021;160:84–93. doi: 10.1016/j.resuscitation.2021.01.019 7. Perkins GD, Kenna C, Ji C, Deakin CD, Nolan JP, Quinn T, Scomparin C, Fothergill R, Gunson I, Pocock H, et al. The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial. Intensive Care Med. 2020;46:426–436. doi: 10.1007/s00134-019-05836-2 8. Perkins GD, Kenna C, Ji C, Deakin CD, Nolan JP, Quinn T, Fothergill R, Gunson I, Pocock H, Rees N, et al. The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms: Findings from the PACA and PARAMEDIC-2 randomised controlled trials. Resuscitation. 2019;140:55–63. doi: 10.1016/j.resuscitation.2019.05.007 9. Stewart C, Chan PS, Kennedy K, Swanson MB, Girotra S; American Heart Association’s Get With The Guidelines (GWTG) Resuscitation Investigators. American Heart Association’s Get With The Guidelines (GWTG) Resuscitation Investigators. Hospital Variation in Epinephrine Administration Before Defibrillation for Cardiac Arrest Due to Shockable Rhythm. Crit Care Med. 2024;52:878–886. doi: 10.1097/CCM.0000000000006203 10. Fernando SM, Mathew R, Sadeghirad B, Rochwerg B, Hibbert B, Munshi L, Fan E, Brodie D, Di Santo P, Tran A, et al. Epinephrine in Out-of- Hospital Cardiac Arrest: A Network Meta-analysis and Subgroup Analyses of Shockable and Nonshockable Rhythms. Chest. 2023;164:381–393. doi: 10.1016/j.chest.2023.01.033 11. Elbadawi A, Tan BE, Assaf Y, Elzeneini M, Baig B, Hamed M, Elgendy IY, Mamas M. Meta-Analysis of Efficacy of Vasopressin During Cardiopulmonary Resuscitation. Am J Cardiol. 2022;181:122–129. doi: 10.1016/j.amjcard.2022.06.042 12. An HR, Han YR, Wang TH, Chi F, Meng Y, Zhang CY, Liang JQ, Li XL. Meta- Analysis of the Factors Influencing the Restoration of Spontaneous Circulation After Cardiopulmonary Resuscitation. Front Physiol. 2022;13:834352. doi: 10.3389/fphys.2022.834352 13. Jaeger D, Baert V, Javaudin F, Debaty G, Duhem H, Koger J, Gueugniaud PY, Tazarourte K, El Khoury C, Hubert H, et al; GR-RéAC. Effect of adrenaline dose on neurological outcome in out-of-hospital cardiac arrest: a nationwide propensity score analysis. Eur J Emerg Med. 2022;29:63–69. doi: 10.1097/MEJ.0000000000000891 14. Palatinus HN, Johnson MA, Wang HE, Hoareau GL, Youngquist ST. Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024;201:110266. doi: 10.1016/j.resuscitation.2024.110266 NONVASOPRESSOR MEDICATIONS DURING CARDIAC ARREST Recommendations for Nonvasopressor Medications in Adult Cardiac Arrest COR LOE Recommendations 2b B-R 1. For adults in cardiac arrest amiodarone or lidocaine may be considered for ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) that is unresponsive to defibrillation. 2b C-LD 2. For adults in cardiac arrest, the use of β-blockers, bretylium, procainamide, or sotalol for VF/pVT unresponsive to defibrillation is of uncertain benefit. 2b C-LD 3. For adults in cardiac arrest, the use of steroids is of uncertain benefit. 3: No Benefit B-R 4. For adults in cardiac arrest, routine administration of calcium is not recommended. 3: No Benefit B-R 5. For adults in cardiac arrest, routine administration of sodium bicarbonate is not recommended. 3: No Benefit B-R 6. For adults in cardiac arrest, routine administration of magnesium is not recommended. Synopsis Pharmacological treatment of cardiac arrest is provided (if indicated) when ROSC is not achieved by CPR and defibrillation.1 Treatments include vasopressor agents such as epinephrine (discussed in Recommendations for Vasopressor Medications During Cardiac Arrest) as well as drugs without direct hemodynamic effects (nonvasopressors) and their administration is delineated in Figure 2. The latter group includes antiarrhythmic medications (which include β- blockers), magnesium, sodium bicarbonate, calcium, and steroids, many of which are commonly administered by health care professionals, including EMS, during cardiac arrest. Although theoretically attractive and of modest benefit in animal studies, none of these therapies have definitively demonstrated improvement in survival after cardiac arrest. Some, however, offer potential benefit in selected populations and circumstances. Guidance for the treatment of cardiac arrest due to hyperkalemia, including the use of calcium and sodium bicarbonate for this indication, is presented in Electrolyte Abnormalities within Part 10. Special Circumstances.2 In addition, Part 10 offers guidance for the management of cardiac arrest due to toxic ingestion that discusses the administration of these medications in these specific circumstances. Guidance for management of torsades de pointes is presented in Recommendations for Polymorphic VT later in these guidelines. Recommendation-Specific Supportive Text 1 The 2023 AHA focused update on adult advanced cardiovascular life support3 and ILCOR’s 2024 CoSTR summary4 addressed administration of parenteral antiarrhythmic medications to patients with cardiac arrest unresponsive to defibrillation. Downloaded from http://ahajournals.org by on October 7, 2026