New recommendations allow for a second 50 mg IVP dose of alteplase in patients in cardiac arrest with known or high suspicion for PE, who had objective evidence response to the first alteplase 50 mg IVP dose but did not sustain ROSC. Pharmacy currently prepares the first 50 mg IVP, outside of our system ED locations, in a syringe as ready-to-administer with goal availability from request to delivery of <15 min. With anticipated second dose being given 15 min after the first dose, if there is evidence of partial response, we are wondering how other institutions operationalize their response.

Do you have 24/7 pharmacist participation in codes?
Do you have a member of the code response bring an alteplase kit to every code OR retrieve the kit when there is high suspicion of PE?
If yes, what are the contents of the kit?
How do you ensure the second dose is indicated?
How do you ensure a 15 min interval between first and second dose?