Should persistant VF/VT be identified following the third shock give amiodarone and continue the algorithm. There is no proof this increases neurologically intact survival.
Lignocaine may be given as a 100 mg or 1-1.5 mg/kg bolus intravenously, in the unlikely event of amiodarone not being available [2]. Do not give lignocaine if amiodarone has been given already. An additional bolus of lidocaine 50 mg can also be given after five defibrillation attempts.[1]
A 20 ml saline flush should follow any intravenous drug in cardiac arrest, followed by elevation of the arm for 10-20 seconds.
Learning bite
Give adrenaline 1 mg IV and amiodarone 300 mg IV intravenously if VT/VF persists after three shocks.