Why epinephrine in cardiac arrest

Significantly, survivors given epinephrine were more likely to be neurologically impaired, compared with those given placebo. However, much remains unanswered with regards to the optimal dose, dose interval and timing of epinephrine administration, although there are clues from registry and database studies suggesting that smaller doses given earlier and less frequently may be a better strategy.

Whether epinephrine administration during cardiac arrest should continue in its current format, or whether alternative strategies may be more optimal, needs to be considered in detail. Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs. The effects of graded doses of epinephrine on regional myocardial blood flow during cardiopulmonary resuscitation in swine.

Intravenous drug administration during out-of-hospital cardiac arrest: A randomized trial. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial.

Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. Evaluation of pre-hospital administration of adrenaline epinephrine by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study. Effects of prehospital epinephrine during out-of-hospital cardiac arrest with initial non-shockable rhythm: an observational cohort study.

Crit Care. Large, prospective clinical trials are needed to identify rational alternatives to epinephrine or modification of dosage and timing.

The authors are not supported by, nor maintain any financial interest in, any commercial activity that may be associated with the topic of this article. Sign In or Create an Account. Advanced Search. Sign In. Skip Nav Destination Article Navigation. Close mobile search navigation Article navigation. Volume , Issue 4. Previous Article Next Article.

Competing Interests. Article Navigation. Editorial Views April Vijay Krishnamoorthy, M. Address correspondence to Dr. Krishnamoorthy: vkrish u. This Site. Google Scholar. Monica S. Vavilala, M. Michael R. Fettiplace, M. Guy Weinberg, M. Author and Article Information. Accepted for publication September 19, Anesthesiology April , Vol. Get Permissions. View large Download slide. Search ADS. Hypertonic gum acacia and glucose in the treatment of secondary traumatic shock.

The production of shock by the prolonged continuous injection of adrenalin in unanesthetized dogs. The effect of epinephrine on arteriovenous shunts in the pathogenesis of shock. Achievement of ROSC was analyzed in patients who received epinephrine vs those who did not receive epinephrine. These groups were further subdivided into presenting rhythms: shockable vs non-shockable rhythms V-fib or pulseless V-tach vs PEA or asystole. Although more patients in the epinephrine group were more likely to be admitted to the hospital, patients in the epinephrine group were less likely to be discharged from the hospital and less likely to be discharged with favorable neurologic outcome.

However, results were confounded by the observation that patients in the epinephrine group were more likely to be defibrillated and intubated as well as to receive longer resuscitative efforts. Lower-Dose Epi: Fisk et al. A study by Fisk et al. The 1 mg higher dose was given for the first 4 years of the study.

In , 0. The study was subdivided into shockable vs non-shockable rhythm. For those with a non-shockable rhythm, survival was 4. It was concluded that lower dose epinephrine neither improved favorable neurologic outcome nor improved survival to discharge. A recent systematic review and meta-analysis published this year compared epinephrine to placebo in cardiac arrest. Kempton et al. The primary outcome was survival to hospital discharge, with achievement of ROSC being a secondary outcome.

Both the Jacobs and Olasveengen study were included in this review. However, epinephrine did not improve neurological outcome. It also did not increase the rate of survival to discharge.

While epinephrine use has been shown to increase the chance of ROSC in OHCA, it has not been shown to improve survival to hospital discharge nor neurologic outcome. It is important to recognize that these studies do not necessarily conclude that epinephrine should not be used in cardiac arrest. Rather, they should drive us to further research ways to improve our management of cardiac arrest.

Physiologic approach to cardiac arrest has increasingly been driving practice changes and developing cutting edge methods in resuscitation medicine. Furthermore, we should also consider the ethical question of whether we should emphasize more on neurological outcomes in OHCA cases. Perhaps the importance of these studies is to remind us to step outside of the protocol and to consider individualizing our management approach.

Therefore taking us back to the physiology and challenging us to do away with an algorithm that has simplified our management strategy for over 50 years. Am J Emerg Med. Not Given - post hoc analysis of a randomized clinical trial.