What is the recommended action if there is no return of spontaneous circulation 15 minutes after the first dose of alteplase?

If there is no return of spontaneous circulation (ROSC) after 15 minutes following the first dose of alteplase, the recommended action is to give an additional 50-mg bolus dose IV/IO and continue resuscitation for 15-90 minutes. This approach aligns with the guidelines aimed at supporting patients who are experiencing a severe cardiac event, such as acute myocardial infarction or massive pulmonary embolism, where thrombolytics like alteplase are used to dissolve clots and restore blood flow.

The rationale behind administering an additional dose of alteplase and continuing resuscitation for a longer duration is based on the critical nature of achieving ROSC in cases of cardiac arrest. By providing a second dose of the thrombolytic, there is a potential to further dissolve the clot responsible for the obstruction in circulation, thereby enhancing the likelihood of restoring cardiac function. Continuing resuscitation efforts for an extended period allows for the possibility of sustaining adequate perfusion and increasing the chances of successful resuscitation, particularly since the effectiveness of thrombolytics can sometimes take additional time to manifest.

In comparison, the other options do not support the necessary and ongoing efforts to restore circulation effectively. Ceasing resuscitation efforts prematurely would negate any opportunities