What is the dose and schedule for amiodarone during persistent shockable arrest?

• A. 300 mg IV/IO bolus; if VF/pVT persists, give a second dose of 150 mg
• B. 150 mg IV bolus; if VF/pVT persists, give second dose of 150 mg
• C. 450 mg IV bolus as a single dose
• D. 600 mg IV bolus; no further dosing

Answer: (C)

Amiodarone is given as an initial bolus of 300 mg IV/IO during persistent shockable arrest. If the rhythm remains VF/pVT after that initial dose, a second bolus of 150 mg IV/IO should be given. This can be repeated up to a total of 450 mg if needed. The idea is to start with the lower, guideline-recommended 300 mg and only add more if defibrillation and CPR continue to be unsuccessful. A single 450 mg bolus does not follow the recommended schedule, which is why it’s not the best choice.