According to a 2025 American Health Association (AHA) Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, pharmacists are considered one of the integral members of the in-hospital cardiac arrest system of care and the resuscitation team. Their inclusion as part of the interdisciplinary response during a code enhances compliance with Advanced Cardiac Life Support (ACLS) guidelines and contributes to improved resuscitation care quality. Pharmacists participate directly in resuscitation and post-resuscitation care, leveraging their expertise in medications to support the team. This collaborative model, often structured with specific role assignments like the pit crew model, is associated with better clinical outcomes, underscoring the importance of integrating pharmacists into structured training and response protocols for cardiac arrest. [1]
Based on the European Resuscitation Council Guidelines 2025, while there is no specific recommendation mandating the inclusion of pharmacists, the guidelines emphasize a comprehensive system-wide approach focused on multidisciplinary teams. Emergency medical service organizations are encouraged to establish specialized prehospital critical care teams and implement structured decision-making protocols, including for the termination of resuscitation. Furthermore, healthcare systems are advised to develop and implement multidisciplinary policies for the long-term follow-up care of both cardiac arrest survivors and their co-survivors, supported by adequate professional education to identify and address their needs. [2]
A 2020 position paper, published collaboratively by the Society of Critical Care Medicine, the American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-System Pharmacists, aimed to update critical care pharmacy practice recommendations established 20 years prior. A total of 15 pharmacists from diverse settings and roles in critical care pharmacy were gathered to create the paper, in which they employed a modified Delphi method to establish consensus, requiring greater than 66% agreement for recommendation acceptance. In summary, the pharmacist serves as an essential and integrated member of the interdisciplinary team, providing comprehensive, patient-centered medication management within the critical care setting. Their core clinical role involves daily patient care rounds, where they conduct independent assessments, prospectively evaluate all drug therapies for appropriateness and safety, and provide real-time consultation and pharmacokinetic monitoring. A critical duty is responding to all resuscitation and time-sensitive emergencies, such as cardiac arrest, leveraging ACLS certification to enhance guideline compliance and patient outcomes. Beyond direct care, the pharmacist ensures medication safety through stewardship initiatives, cost-containment, and the prevention of adverse drug events. They are pivotal in system leadership, developing drug protocols, leading quality improvement projects, and educating the entire healthcare team. Furthermore, they contribute to research, mentor trainees, and engage in professional development to maintain expertise, collectively ensuring optimized, evidence-based pharmacotherapy for critically ill patients. [3]
In 2024, the American Journal of Emergency Medicine published a systematic review examining the role of pharmacists during in-hospital resuscitation and medical emergency response events. This review synthesized findings from 30 studies, including 29 cohort studies and one randomized controlled trial, and focused on the impact of pharmacists on medication administration and patient outcomes. The systematic review demonstrated that 23 out of 30 studies reported a statistically significant reduction in time to administer medications when a pharmacist was involved. The inclusion of pharmacists enabled more appropriate medication use and enhanced adherence to clinical guidelines. Pharmacist responsibilities included retrieval of patient specific information, dose calculation or verification, obtaining and preparing medications, infusion pump programming, and medication information and drug therapy recommendations. Some studies also included pharmacists in documentation and recording of all activities while providing real time quality assurance during the event. During acute stroke, pharmacists were also responsible for screening for contraindications to thrombolysis along with blood pressure management and monitoring. Preparation of supply and infusion pump programming were mentioned. Pharmacists could also assist with informing patients and family about the risk and benefits of thrombolysis. While numerous studies exist, there lacks a large, robust source of clinical trials. [4]
A 2024 article detailed the development and implementation of an emergency response curriculum (ERC) designed specifically for pharmacists at Brigham and Women’s Hospital. This training included a comprehensive didactic lecture followed by immersive simulation scenarios to enhance pharmacists' preparedness in medical emergencies. The didactic component consisted of a 60-minute lecture that provided an overview of ACLS algorithms and the pharmacists' roles during hospital emergencies, focusing on the procurement and preparation of medications. Following this, participants engaged in high-fidelity simulation exercises, including scenarios such as ventricular fibrillation (VF) arrest due to hyperkalemia and pulseless electrical activity (PEA) arrest owing to hemorrhagic shock. Each participant had the opportunity to manage the code cart and practice medication preparation, while also engaging in tasks like airway management and chest compressions, thereby facilitating hands-on experience in a structured clinical setting. According to the findings, the curriculum significantly improved pharmacists’ self-perceived confidence, with median confidence scores increasing from 3 pre-training to 4 post-training on a 5-point Likert scale. Participants, mostly pharmacy residents, reported heightened readiness to fulfill their roles in emergency situations. Furthermore, 95% of participants expressed a preference for the ERC to be implemented annually or multiple times a year, reflecting its perceived value in fostering critical skills such as teamwork, communication, and leadership in high-acuity environments. The authors concluded that this ERC model, with its blend of didactic and experiential learning, significantly enhances pharmacists' competencies in code responses, and advocated for broader adoption and further evaluation of similar training programs in clinical settings. [5]
A 2021 descriptive quality improvement study evaluated the involvement of clinical pharmacists in a rapid response team (RRT) during cardiopulmonary resuscitation at a single tertiary academic medical center. Pharmacists, who were previously not part of the RRT due to operational and financial constraints, began participating in cardiopulmonary arrest RRT activations in April 2019. The pharmacist's role on the RRT for cardiopulmonary arrest includes responding to activations to provide direct clinical support. Key activities encompass assisting with crash cart and medication preparation, facilitating urgent medication procurement, and ensuring proper billing to prevent financial losses. The pharmacist also delivers essential drug information to the team regarding selection, dosing, and administration. A critical component of the role is proactively identifying and preventing potential adverse drug events during these emergencies. Pharmacists intervened in 19 RRT activations, conducting an average of 5.5 interventions per event with a predominant focus on procuring necessary medications, such as epinephrine and sodium bicarbonate, and providing crucial drug information. Survey results from the interprofessional medical emergency response improvement team (MERIT) before and after the pharmacists' involvement indicated a strong positive perception. The majority of respondents agreed that the pharmacists' presence improved teamwork, reduced medication turnaround time, decreased medication errors, and potentially prevented poor outcomes. The quality improvement initiative demonstrated that pharmacists play a vital role in enhancing the efficiency and effectiveness of RRTs during cardiopulmonary arrest by ensuring timely medication administration and improving overall patient safety, which was underscored by the positive feedback received from the MERIT survey. [6]
Per a 2017 study, pharmacists on an RRT play a critical role in optimizing the medication-use process during emergencies. Their primary responsibilities include providing direct clinical support by assisting with medication selection, dose verification, and administration guidance to ensure appropriate pharmacotherapy. A key impact is significantly improving medication accessibility and timeliness; pharmacist involvement reduced the median medication administration time from the central pharmacy by half. Additionally, pharmacists facilitate medication procurement, help prevent adverse drug events, and contribute to system improvements, such as optimizing automated dispensing cabinet stocks for common emergency medications. Through these interventions, pharmacists enhance the efficiency and safety of the RRT, helping to stabilize patients more rapidly. [7]