Amiodarone & Lidocaine in Arrest
Objective: Use amiodarone or lidocaine for VF or pulseless VT after shocks and CPR, per protocol. Do not use them for asystole, PEA, a high-potassium sine wave, or every wide complex. They do not replace defibrillation. Your protocol card sets the amount.
Why this matters
Amiodarone and lidocaine are arrest antiarrhythmics. It is easy to give one too early, or for the wrong rhythm. For VF or pulseless VT that continues after shocks and CPR, either drug may be considered. The evidence is not strong enough to say one is better. Neither drug replaces high-quality CPR and defibrillation. See shockable arrest and high-quality CPR. Your protocol card sets the amount. This site does not list milligrams.
- Still VF or pulseless VT after shocks? Then amiodarone or lidocaine may fit.
- Asystole or PEA is not treated with this drug.
- If the rhythm is wide and slow in a dialysis patient, think calcium, not amiodarone.
- Read the vial. Amiodarone and lidocaine are not the same concentration.
Clinical sequence
- Ask if this is still VF or pulseless VT after shocks. If yes, amiodarone or lidocaine may fit during CPR. If no, do not give the drug.
- Asystole and PEA are not this drug. Do not give it without a shockable rhythm.
- A wide, slow rhythm in a dialysis patient is a calcium problem, not a first dose of amiodarone. Do not use these drugs for every wide complex. See hyperkalemia.
- Read the vial. Amiodarone and lidocaine are not the same concentration. Your protocol picks one drug and the amount. Do not give both unless medical direction says so.
When They Fit
- Shock-refractory VF or pulseless VT, after defibrillation attempts, during CPR.
- Either drug may be used. Follow your dose card. Say the drug, the dose, and the route out loud, and wait for your partner to confirm.
- This site does not list milligrams. Arrest cards describe a first dose and a repeat. Your protocol sets that.
When They Do Not
- Asystole or PEA, given as a just-in-case antiarrhythmic.
- High-potassium wide complex or a sine wave. Protect the heart membrane with calcium.
- A patient who still has a pulse and a stable wide-complex tachycardia is a different pathway. That is a protocol infusion, not the arrest dose given from memory.
- Polymorphic VT from a long QT, torsades, is a magnesium and defibrillation problem, not a first dose of amiodarone. See magnesium.
Safety points
- Amiodarone can drop the blood pressure. Hypotension after return of circulation is a known effect. That does not mean you withhold it in refractory VF if your protocol includes it.
- Too much lidocaine can cause seizures and other brain effects. That is another reason not to add extra from memory.
- If you are interrupted while drawing, start over. The rights still apply in a code. See medication rights.
Common errors
- Giving the antiarrhythmic before the first shock.
- Giving both amiodarone and lidocaine because both were in the drawer.
- Calling fine VF asystole, then skipping both the shocks and the drug. See fine VF.
Practice
One-minute check
With a partner, say antiarrhythmic yes or no, and name the first treatment: (1) VF after three shocks; (2) asystole; (3) sine-wave PEA after missed dialysis.
Related: Shockable Arrest, Wide-complex tachycardia, Epinephrine.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language. Your protocol still decides.
- AHA 2025 Part 9: Adult Advanced Life Support — Amiodarone or lidocaine may be used for shock-refractory VF or pulseless VT. There is not enough evidence to prefer one.
- Your protocol picks the drug and the dose. Defibrillation and CPR still come first.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.