Asad Jamal Ansari,
Saurabh Kumar Chauhan,
- Lecturer, Faculty of Pharmacy, Integral University, Uttar Pradesh, India
- Researcher, Department of Pharmacology, School of Pharmaceutical Education and Research (SPER), Jamia Hamdard, New Delhi, India
Abstract
Cardiopulmonary resuscitation (CPR) represents an essential emergency procedure designed to reestablish spontaneous circulation and enhance survival rates among individuals suffering cardiac arrest. Successful resuscitation necessitates prompt clinical judgment, expeditious pharmaceutical interventions, compliance with advanced cardiovascular life support (ACLS) guidelines, and synchronized interprofessional collaboration. During recent decades, clinical pharmacists have gained greater incorporation within emergency response and resuscitation units owing to their specialized knowledge in medication oversight, pharmacotherapeutic enhancement, and patient protection. This narrative examination consolidates existing evidence concerning clinical pharmacist involvement during CPR within intensive care environments and emergency medicine departments. Clinical pharmacists provide substantial contributions through pharmaceutical preparation and delivery, dosage confirmation, treatment guidance, medication safety surveillance, and enhancement of time-sensitive therapeutic interventions throughout resuscitation procedures. Their involvement has demonstrated associations with improved ACLS protocol compliance, decreased pharmaceutical errors, strengthened interprofessional communication, and enhanced emergency medication distribution efficiency. Pharmacists additionally fulfil crucial functions in post-arrest management via hemodynamic assessment, pharmacotherapeutic enhancement, and detection of drug-related complications in critically ill individuals. Furthermore, educational initiatives, simulation-based learning, ACLS and basic life support (BLS) credentialing, and interdisciplinary partnerships remain vital for sustaining pharmacist proficiency in emergency response situations. Although pharmacist recognition within resuscitation teams continues expanding, obstacles such as insufficient personnel, training inconsistencies, absence of uniform role specifications, and limited data regarding extended clinical results persist in influencing their incorporation into emergency medical services. Prospective investigations emphasizing standardized practice models and extended clinical outcomes may additionally reinforce clinical pharmacist contributions to cardiopulmonary resuscitation and critical care administration
Keywords: Cardiopulmonary resuscitation, clinical pharmacist, cardiac arrest, advanced cardiovascular life support, emergency medicine, medication safety
[This article belongs to International Journal of Emergency and Trauma Nursing and Practices ]
References
- Clinical Pharmacist Services in the Emergency Department. Ann Emerg Med. 2015 Oct;66(4):444-5. doi: 10.1016/j.annemergmed.2015.07.513. PMID: 26398179.
- Patel H, Wee M, Tejani AM, Lau A. Clinical Outcomes of Pharmacist Involvement in Cardiac Arrest and Trauma Resuscitations: A Scoping Review. Pharmacy (Basel). 2025 Jun 24;13(4):89. doi: 10.3390/pharmacy13040089. PMID: 40700260; PMCID: PMC12286068.
- Eppert HD, Reznek AJ. ASHP guidelines on emergency medicine pharmacist services. Am J Health Syst Pharm. 2011;68:e81–e95.
- Farmer BM, Hayes BD, Rao R, Farrell N, Nelson L. The role of clinical pharmacists in the emergency department. J Med Toxicol. 2018;14(1):114–116. doi:10.1007/s13181-017-0634-4. Epub 2017 Oct 26. PubMed: 29075954. PubMed Central: PMC6013729.
- Morgan SR, Acquisto NM, Coralic Z, Basalyga V, Campbell M, Kelly JJ, Langkiet K, Pearson C, Sokn E, Phelan M. Clinical pharmacy services in the emergency department. Am J Emerg Med. 2018 Oct;36(10):1727-1732. doi: 10.1016/j.ajem.2018.01.056. Epub 2018 Jan 31. PMID: 29475633.
- Punj E, Collins A, Agravedi N, Marriott J, Sapey E. What is the evidence that a pharmacy team working in an acute or emergency medicine department improves outcomes for patients: A systematic review. Pharmacol Res Perspect. 2022;10(5):e01007. doi:10.1002/prp2.1007. PubMed: 36102210.
- Bolt J, Semchuk W, Loewen P, Bell A, Strugari C. A Canadian survey of pharmacist participation during cardiopulmonary resuscitation. Can J Hosp Pharm. 2015;68(4):290–295. doi:10.4212/cjhp.v68i4.1468. PubMed: 26327702.
- Draper HM, Eppert JA. Association of pharmacist presence on compliance with advanced cardiac life support guidelines during in-hospital cardiac arrest. Ann Pharmacother. 2008;42(4):469–474. doi:10.1345/aph.1K475. PubMed: 18349308.
- Bingham AL, Kavelak HL, Hollands JM, Finn LA, Delic JJ, Schroeder N, et al. Advanced cardiac life support certification for student pharmacists improves simulated patient survival. Curr Pharm Teach Learn. 2020;12(8):975–980. doi:10.1016/j.cptl.2020.04.002. PubMed: 32565000.
- Scarponcini TR, Edwards CJ, Rudis MI, Jasiak KD, Hays DP. The role of the emergency pharmacist in trauma resuscitation. J Pharm Pract. 2011;24(2):146–159. doi:10.1177/0897190011400550. PubMed: 21712210.
- Patanwala AE, Hays DP. Pharmacist’s activities on a trauma response team in the emergency department. Am J Health Syst Pharm. 2010;67(18):1536–1538. doi:10.2146/ajhp090311. PubMed: 20811031.
- Montgomery K, Hall AB, Keriazes G. Pharmacist’s impact on acute pain management during trauma resuscitation. J Trauma Nurs. 2015;22(2):87–90. doi:10.1097/JTN.0000000000000112. PubMed: 25768964.
- McGinnis C, Kim C, Qureshi A, Scholle C, Ramanan R. Evaluation and perception of clinical pharmacist participation in a rapid response team during cardiopulmonary resuscitation. Qual Manag Health Care. 2022;31(1):34–37. doi:10.1097/QMH.0000000000000325. PubMed: 34694255.
- Currey EM, Falconer N, Isoardi KZ, Barras M. Impact of pharmacists during in-hospital resuscitation or medical emergency response events: A systematic review. Am J Emerg Med. 2024;75:98–110. doi:10.1016/j.ajem.2023.10.020. Epub 2023 Oct 22. PubMed: 37939522.
- Roman C, Dooley M, Fitzgerald M, Smit V, Cameron P, Mitra B. Pharmacists in trauma: A randomised controlled trial of emergency medicine pharmacists in trauma response teams. Emerg Med J. 2024;41(7):397–403. doi:10.1136/emermed-2022-212934. PubMed: 38749667.
- Holmberg MJ, Ross CE, Fitzmaurice GM, Chan PS, Duval-Arnould J, Grossestreuer AV, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019;12(7):e005580. PMID: 31545574.
- Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. 2024 heart disease and stroke statistics: A report of US and global data from the American Heart Association. Circulation. 2024;149(8):e347–e913. doi:10.1161/CIR.0000000000001209. PMID: 38264914.
- Girotra S, Nallamothu BK, Spertus JA, Li Y, Krumholz HM, Chan PS, et al. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012;367(20):1912–1920. doi:10.1056/NEJMoa1109148. PMID: 23150959.
- Wiberg S, Holmberg MJ, Donnino MW, Kjaergaard J, Hassager C, Witten L, et al. Age-dependent trends in survival after adult in-hospital cardiac arrest. Resuscitation. 2020;151:189–196. doi:10.1016/j.resuscitation.2020.03.008. PMID: 32246986.
- Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: Incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007;33(2):237–245. doi:10.1007/s00134-006-0326-z. PMID: 17019558.
- Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Circulation. 2018;137(12):e67–e492. doi:10.1161/CIR.0000000000000558. PMID: 29386200.
- Cagino LM, Moskowitz A, Nallamothu BK, McSparron J, Iwashyna TJ, Get With The Guidelines-Resuscitation Investigators. Trends in return of spontaneous circulation and survival to hospital discharge for in-intensive care unit cardiac arrests. Ann Am Thorac Soc. 2023;20(7):1012–1019. doi:10.1513/AnnalsATS.202205-393OC. PMID: 36939838.
- Andersen LW, Holmberg MJ, Berg KM, Donnino MW, Granfeldt A. In-hospital cardiac arrest: A review. JAMA. 2019;321(12):1200–1210. doi:10.1001/jama.2019.1696. PMID: 30912843.
- Merchant RM, Becker LB, Brooks SC, Chan PS, Del Rios M, McBride ME, et al. The American Heart Association emergency cardiovascular care 2030 impact goals and call to action to improve cardiac arrest outcomes: A scientific statement from the American Heart Association. Circulation. 2024;149(8):e914–e933. doi:10.1161/CIR.0000000000001196. PMID: 38250800.
- Khera R, Tang Y, Link MS, Krumholz HM, Girotra S, Chan PS. Association between hospital recognition for resuscitation guideline adherence and rates of survival for in-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes. 2019;12(3):e005429. doi:10.1161/CIRCOUTCOMES.118.005429. PMID: 30871337.
- Roessler LL, Holmberg MJ, Pawar RD, Lassen AT, Moskowitz A, Get With The Guidelines-Resuscitation Investigators. Resuscitation quality in the ICU: A retrospective analysis. Chest. 2022;162(3):569–577. doi:10.1016/j.chest.2022.03.015. PMID: 35305970.
- Kim JY, Hwang SO, Shin SD, Yang HJ, Chung SP, Lee SW, et al. Korean Cardiac Arrest Research Consortium (KoCARC): Rationale, development, and implementation. Clin Exp Emerg Med. 2018;5(3):165–176. doi:10.15441/ceem.17.259. PMID: 30269452.
- Ro YS, Shin SD, Song KJ, Lee EJ, Kim JY, Ahn KO, et al. A trend in epidemiology and outcomes of out-of-hospital cardiac arrest by urbanization level: A nationwide observational study from 2006 to 2010 in South Korea. Resuscitation. 2013;84(5):547–557. doi:10.1016/j.resuscitation.2012.12.020. PMID: 23313428.
- Nolan JP, Neumar RW, Adrie C, Aibiki M, Berg RA, Böttiger BW, et al. Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication. A scientific statement from the International Liaison Committee on Resuscitation. Resuscitation. 2008;79:350–379. doi:10.1016/j.resuscitation.2008.09.017. PMID: 18963350.
- Kim JH, Oh YM, So BH, Hong TY, Lee WJ, Choi SP, Park KN. Systemic complications in comatose survivors following cardiopulmonary resuscitation. J Korean Soc Emerg Med. 2008;19(1):88–93.
- Lee BY, Hong SB. Rapid response systems in Korea. Acute Crit Care. 2019;34:108–116. doi:10.4266/acc.2019.00535. PMID: 31723915.
- Neumar RW, Nolan JP, Adrie C, Aibiki M, Berg RA, Böttiger BW, Callaway C, et al. Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation and affiliated organizations. Circulation. 2008;118:2452–2483. doi:10.1161/CIRCULATIONAHA.108.190652. PMID: 18948368.
- Opie LH. Reperfusion injury and its pharmacologic modification. Circulation. 1989;80(4):1049–1062. doi:10.1161/01.CIR.80.4.1049. PMID: 2571429.
- White BC, Grossman LI, Krause GS. Brain injury by global ischemia and reperfusion: A theoretical perspective on membrane damage and repair. Neurology. 1993;43(9):1656–1665. doi:10.1212/WNL.43.9.1656. PMID: 8414008.
- Neumar RW. Molecular mechanisms of ischemic neuronal injury. Ann Emerg Med. 2000;36(5):483–506. doi:10.1067/mem.2000.110995. PMID: 11054204.
- Yao Y, Johnson NJ, Perman SM, Ramjee V, Grossestreuer AV, Gaieski DF. Myocardial dysfunction after out-of-hospital cardiac arrest: Predictors and prognostic implications. Intern Emerg Med. 2018;13(5):765–772. doi:10.1007/s11739-017-1756-z. PMID: 28983759.
- Ray L, Acquisto NM, Coralic Z, Feldman R, Mercer K, Zimmerman DE, et al. A national survey of medication utilization for cardiac resuscitation in the emergency department: A survey of emergency medicine pharmacists. Am J Health Syst Pharm. 2024;81(24):1313–1321. doi:10.1093/ajhp/zxae186. PMID: 38990863.
- Robb C, Douglas N, McKechnie E, Upton D. Evaluation of the role of pharmacists in a cardiac arrest team. Hosp Pharm. 2003;10(1):22–24.
- Lamkin L, Lindsey S, Weant K, Shoff H, Pinkston C. Implications of the presence of an emergency medicine pharmacist during critical care trauma patient resuscitation. J Am Coll Clin Pharm. 2019;2(3):251–256. doi:10.1002/jac5.1068.
- Fairbanks RJ. Results of the emergency pharmacist outcomes study. In: Proceedings of the ASHP Mid-Year Clinical Meeting; Las Vegas, NV, USA. 2007 Dec 5. Rochester (NY): University of Rochester School of Medicine; 2007.
- Lada P, Delgado G Jr. Documentation of pharmacists’ interventions in an emergency department and associated cost avoidance. Am J Health Syst Pharm. 2007;64(1):63–68. doi:10.2146/ajhp050213. PMID:17189582.
- Machado C, Barlows TG III, Marsh WA, Coto-Depani Y, Dalin G. Pharmacists on the emergency cardiopulmonary resuscitation team: Their responsibilities, training, and attitudes. Hosp Pharm. 2003;38(1):40–49. doi:10.1177/001857870303800113.
- Roddy M, Fowler C. Optimization of pediatric medical emergency training (PedMET) program for pharmacists in the inpatient setting. J Pediatr Pharmacol Ther. 2024;29(4):417–424. doi:10.5863/1551-6776-29.4.417. PMID:39144395.
- Levy B, Perez P, Perny J, Thivilier C, Gerard A. Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study. Crit Care Med. 2011;39(3):450–455. doi:10.1097/CCM.0b013e3181ffe0eb. PMID:21037469.
- Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration – 2008. Am J Health Syst Pharm. 2009;66(10):926–946. doi:10.2146/ajhp080715. PMID:19420311.
- Bond CA, Raehl CL, Franke T. Clinical pharmacy services and hospital mortality rates. Pharmacotherapy. 1999;19(5):556–564. doi:10.1592/phco.19.8.556.31531. PMID:10331818.
- Bond CA, Raehl CL. Adverse drug reactions in United States hospitals. Pharmacotherapy. 2006;26(5):601–608. doi:10.1592/phco.26.5.601. PMID:16637789.
- Bond CA, Raehl CL. Clinical pharmacy services, pharmacy staffing, and hospital mortality rates. Pharmacotherapy. 2007;27(4):481–493. doi:10.1592/phco.27.4.481. PMID:17381374.
- Ortmann MJ, Johnson EG, Jarrell DH, Bilhimer M, Hayes BD, Mishler A, Pugliese RS, Roberson TA, Slocum G, Smith AP, Yabut K, Zimmerman DE. ASHP guidelines on emergency medicine pharmacist services. Am J Health Syst Pharm. 2021;78(3):261–275. doi:10.1093/ajhp/zxaa378. PMID:33480409.
- Tully MP, Seston EM. Impact of pharmacists providing a prescription review and monitoring service in ambulatory care or community practice. Ann Pharmacother. 2000;34(11):1320–1331. doi:10.1345/aph.19374. PMID:11098348.
- Coast-Senior EA, Kroner BA, Kelley CL, Trilli LE. Management of patients with type 2 diabetes by pharmacists in primary care clinics. Ann Pharmacother. 1998;32(6):636–641. doi:10.1345/aph.17095. PMID:9640480.
- Kaboli PJ, Hoth AB, McClimon BJ, Schnipper JL. Clinical pharmacists and inpatient medical care: A systematic review. Arch Intern Med. 2006;166(9):955–964. doi:10.1001/archinte.166.9.955. PMID:16682568.
- Chisholm-Burns MA, Graff Zivin JS, Lee JK, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, Abraham I, Palmer J. Economic effects of pharmacists on health outcomes in the United States: A systematic review. Am J Health Syst Pharm. 2010;67(19):1624–1634. doi:10.2146/ajhp100077. PMID:20852164.
- Skains RM, Hayes JM, Selman K, Zhang Y, Thatphet P, Toda K, et al. Emergency department programs to support medication safety in older adults: A systematic review and meta-analysis. JAMA Netw Open. 2025;8:e250814. doi:10.1001/jamanetworkopen.2025.0814.
- Brandner O, Campisi L, Nguyen AL. Pediatric pharmacists’ participation in cardiopulmonary resuscitation events. J Pediatr Pharmacol Ther. 2025;30(4):520–525. doi:10.5863/JPPT25-00045. PMID:40821421.
| Volume | 04 | |
| Issue | 01 | |
| Received | 10/05/2026 | |
| Accepted | 12/05/2026 | |
| Published | 30/05/2026 | |
| Publication Time | 20 Days |
