Epinephrine for cardiac arrest
- 1 January 2013
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Cardiology
- Vol. 28 (1), 36-42
- https://doi.org/10.1097/hco.0b013e32835b0979
Abstract
Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest. Epinephrine increases arterial blood pressure and coronary perfusion during CPR via alpha-1-adrenoceptor agonist effects. However, the dose, timing and indications for epinephrine use are based on limited animal data. Recent studies question whether epinephrine provides any overall benefit for patients. A randomized controlled trial indicates that epinephrine for out-of-hospital cardiac arrest increases return of pulses, but does not significantly alter longer-term survival. Very large, well-controlled, observational studies suggest that, despite increases in return of pulses, epinephrine reduces long-term survival and functional recovery after CPR. Detrimental effects were greatest in patients found in ventricular fibrillation. Laboratory data suggest that harmful epinephrine-induced reductions in microvascular blood flow during and after CPR may offset the beneficial epinephrine-induced increase in arterial blood pressure during CPR. The available clinical data confirm that epinephrine administration during CPR can increase short-term survival (return of pulses), but point towards either no benefit or even harm of this drug for more patient-centred outcomes (long-term survival or functional recovery). Prospective trials are needed to determine the correct dose, timing and patients for epinephrine in cardiac arrest.Keywords
This publication has 38 references indexed in Scilit:
- Potential negative effects of epinephrine on carotid blood flow and ETCO2 during active compression–decompression CPR utilizing an impedance threshold deviceResuscitation, 2012
- Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock. A prospective, randomized pilot study*Critical Care Medicine, 2011
- The effects of epinephrine on outcomes of normothermic and therapeutic hypothermic cardiopulmonary resuscitation*Critical Care Medicine, 2010
- Immediate Percutaneous Coronary Intervention Is Associated With Better Survival After Out-of-Hospital Cardiac ArrestCirculation: Cardiovascular Interventions, 2010
- Nitrite Therapy After Cardiac Arrest Reduces Reactive Oxygen Species Generation, Improves Cardiac and Neurological Function, and Enhances Survival via Reversible Inhibition of Mitochondrial Complex ICirculation, 2009
- Epinephrine reduces cerebral perfusion during cardiopulmonary resuscitation*Critical Care Medicine, 2009
- Ventricular Fibrillation Scaling Exponent Can Guide Timing of Defibrillation and Other TherapiesCirculation, 2004
- A Comparison of Vasopressin and Epinephrine for Out-of-Hospital Cardiopulmonary ResuscitationNew England Journal of Medicine, 2004
- A Comparison of Standard-Dose and High-Dose Epinephrine in Cardiac Arrest outside the HospitalNew England Journal of Medicine, 1992
- High-Dose Epinephrine in Adult Cardiac ArrestNew England Journal of Medicine, 1992