Variabilities in the Use of IV Epinephrine in the Management of Cardiac Arrest Patients

Animal studies in the 1960s first demonstrated the benefits of using epinephrine alongside external compressions and external shock to achieve return of spontaneous circulation (ROSC) in arrested and asphyxiated dogs.1–4 Since then, epinephrine has become integral to the performance of advanced cardiac life support (ACLS) care. The American Heart Association’s (AHA) recommendations in the Emergency Cardiovascular Care (ECC) Guidelines are that a standard dose of 1 mg of 1:10,000 epinephrine every 3–5 minutes “may be reasonable for patients with cardiac arrest.”5 No maximum total dose is delineated, and 1 mg every 3–5 minutes is recommended to be given as needed. Furthermore, no distinction is made in the manual for epinephrine dosing in ventricular fibrillation (v fib) vs. ventricular tachycardia (v tach), or shockable rhythms (v fib and v tach) vs. non-shockable rhythms (asystole, pulseless electrical activity [PEA]) in arrest.5 Current ECC guidelines also mention the use of epinephrine drips to correct post-ROSC hypotension, through IV push doses primarily during cardiac arrest.5 Epinephrine acts on adrenergic receptors in the body to help reverse cardiac arrest and promote ROSC.6 During compressions, vasoconstriction from epinephrine acting on alpha-1-adrenergic receptors helps increase the efficiency of coronary perfusion so that the heart can return to functional capacity; however, this may be at the expense of other organs and the systemic circulation.5,7,8 ...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news