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  1. Adenosine

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In this lesson, we'll go over the medication adenosine and all of its effects, including indications, precautions and contraindications, and pediatric dosages.

Adenosine is effective at terminating supraventricular tachycardia, as it temporarily blocks conduction through the AV node for around 10 seconds.

Pro Tip #1: It's important to note that adenosine does not convert atrial fibrillation, atrial flutter, or other tachycardias that are caused by mechanisms other than a re-entry through the AV node.

Adenosine Indications

Indications for adenosine include:

  • Supraventricular tachycardia, or SVT
  • Tachycardias that are caused by a re-entry at the SA node
  • As a diagnostic tool to distinguish atrial flutter from SVT

Adenosine Precautions and Contraindications

There are some adenosine precautions and contraindications to be aware of, including:

  • Adenosine needs to be administered by rapid IV push

Pro Tip #2: The most common cause of failure when administering adenosine tends to occur when the medication is pushed too slowly.

  • There is typically a brief period of around 10-15 seconds of bradycardia, asystole, or 3rd degree heart block that can occur when administering adenosine

Pro Tip #3: If treating a child who is old enough to understand what is happening to them, you should consider warning them that they might feel a little uncomfortable for a few seconds following adenosine administration.

Which brings up a greater point of emphasis – always try to reassure a pediatric patient that they are in good hands and that you are there to help them and will take good care of them.

Pediatric Dosage of Adenosine

Warning: despite the dosage information that follows, the initial dose of adenosine should be decreased by approximately 75 percent for any pediatric patient who is also receiving carbamazepine or dipyridamole or those patients who have undergone a heart transplant.

Pediatric dosages of adenosine should be delivered either via IV or IO and with a rapid push that will deliver the medication as quickly as possible.

The initial dose of adenosine is .1mg per kilogram of bodyweight (or .1mg/kg), for a maximum dose of 6mg, followed by a normal saline bolus flush of up to 20ml or 20cc.

Pro Tip #4: The primary difference between a cc (cubic centimeter) and an mL (milliliter) is this: Cubic centimeters are used for solid amounts, while milliliters are used for fluid amounts. Otherwise, the measurements are the same and there is no difference in volume. So, 1cc will always equal 1ml.

If the first does of adenosine does not convert the patient's rhythm, a second dose of .2mg/kg can be administered, for a maximum dose of 12mg of adenosine.

And just as before, flush that second dose with a normal saline bolus flush of 20cc, which will help get the medication into the patient's circulatory system much faster.

Pro Tip #5: Make sure you or a member of your team are recording the ECG rhythm during the full drug administration and treatment process, including any changes that might occur.

A Word About Medication Administration During CPR

Ideally, you'll want to administer IO/IV medications during compressions because the blood flow generated by the compressions will help circulate the medications being administered.

According to the 2015 AHA Guidelines Update for CPR and ECC, it's recommended that medications be administered during compressions and immediately before (if compressions are performed while the defibrillator is charging) or after shock delivery. Doing so means that the medications have more time to circulate before the next rhythm check and shock delivery, if required.

All team members who are responsible for administering resuscitation drugs should anticipate and prepare the next drug dose that might be needed after the next rhythm check. All team members should also be familiar with the Pediatric Cardiac Arrest Algorithm and refer to it during the resuscitation attempt to anticipate the next interventions.

Drug tables, charts, or other references should be readily available to expedite the calculation of drug doses. And remember, the use of a color-coded length-based resuscitation tape will help facilitate your rapid estimation of the appropriate drug doses for each pediatric patient based on that patient's weight.

Endotracheal administration of resuscitation drugs will result in lower blood concentrations than instances where the same dose is administered intravascularly or via IO. Studies have also suggested that the lower epinephrine concentration that's achieved when the medication is delivered by the endotracheal route may produce transient β-adrenergic effects.

The β-adrenergic effects can be detrimental to the pediatric patient and may cause hypotension, lower coronary artery perfusion pressure and flow, and reduce the potential for the return of spontaneous circulation (ROSC). Another disadvantage of endotracheal medication delivery is that chest compressions must be interrupted in order for the medications to be delivered via this route.