{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T06:38:32Z","timestamp":1764571112461,"version":"build-2065373602"},"reference-count":47,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T00:00:00Z","timestamp":1701129600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Nearly 565,000 patients will suffer from prehospital and inpatient cardiac arrest in the United States per annum. Cardiopulmonary resuscitation and all associated interventions used to achieve it remain an essential focus of emergency medicine. Current ACLS guidelines give clear instructions regarding mainstay medications such as epinephrine and antiarrhythmics; however, the literature remains somewhat controversial regarding the application of adjunctive therapeutics such as calcium, magnesium, sodium bicarbonate, and corticosteroids. The available data acquired in this field over the past three decades offer mixed pictures for each of these medications on the effects of core metrics of cardiopulmonary resuscitation (e.g., rate of return of spontaneous circulation, survival-to-hospitalization and discharge, 24 h and 30 d mortality, neurological outcome), as well as case-specific applications for each of these interventions (e.g., polymorphic ventricular tachycardia, electrolyte derangements, acidosis, post-arrest shock). This narrative literature review provides a comprehensive summary of current guidelines and published data available for these four agents and their use in clinical practice.<\/jats:p>","DOI":"10.3390\/jcm12237374","type":"journal-article","created":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T11:43:16Z","timestamp":1701171796000},"page":"7374","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Adjunctive Therapeutics in the Management of Cardiopulmonary Resuscitation: A Narrative Literature Review"],"prefix":"10.3390","volume":"12","author":[{"given":"Megan","family":"Hoffer","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9393-5531","authenticated-orcid":false,"given":"Robert C. F.","family":"Pena","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quincy K.","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"},{"name":"Program in Trauma, The R Adams Cowley Shock Trauma Center, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8440-8454","authenticated-orcid":false,"given":"Ali","family":"Pourmand","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e67","DOI":"10.1161\/CIR.0000000000000558","article-title":"Heart disease and stroke statistics\u20142018 update: A report from the American Heart Association","volume":"137","author":"Benjamin","year":"2018","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S366","DOI":"10.1161\/CIR.0000000000000916","article-title":"Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"142","author":"Panchal","year":"2020","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.1001\/jama.2021.20929","article-title":"Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial","volume":"326","author":"Vallentin","year":"2021","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.resuscitation.2022.11.006","article-title":"Effect of calcium in patients with pulseless electrical activity and electrocardiographic characteristics potentially associated with hyperkalemia and ischemia-sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial","volume":"181","author":"Vallentin","year":"2022","journal-title":"Resuscitation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/MEJ.0b013e328358e336","article-title":"Calcium administration during cardiac arrest: A systematic review","volume":"20","author":"Kette","year":"2013","journal-title":"Eur. 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