Vasopressin not used Advanced Cardiac Life Suppo algorithms for cardiopulmonary resuscitation must be followed should cardiac arrest occur. Chest compressions should be initiated immediately and continued until return of spontaneous circulation. If epinephrine is used, small initial doses of <=1 ug[?]kg-1 are preferred to avoid impaired pulmonary gas exchange and increased afterload. Vasopressin is not recommended for use as it has been associated with adverse outcomes in animal models. In the absence of rapid recovery following advanced life suppo measures and intravenous lipid emulsion therapy, early consideration should be given to cardiopulmonary bypass for circulatory suppo. The inotropic effect of lipid emulsion therapy only occurs once the myocardial LA levels are below a threshold that corresponds to ion channel blocking concentrations. This emphasizes the impoance of effective chest compressions to ensure coronary perfusion is sufficient to reduce LA tissue levels in order to obtain the benefit of lipid emulsion therapy. If cardiac output is maintained but there are deleterious CVS effects - such as arrhythmias, conduction block, progressive hypotension, and bradycardia - standard Advanced Cardiac Life Suppo algorithms should be followed with the omission of LA, such as lidocaine, for the treatment of arrhythmia. Amiodarone is the first-line antiarrhythmic in the event of ventricular dysrhythmia.