Epinephrine in Cardiac Arrest

Epinephrine has been a key component of ALS since the first CPR guidelines were published in the early 1960s, and its use has continued with little change in dose or timings over the past 60 years. As well as its positive inotropic and chronotropic properties mediated through beta-agonist properties, the demonstration that epinephrine’s alpha-agonist effects increased aortic diastolic pressure to increase both coronary blood flow (associated with an increased chance of return of spontaneous circulation [ROSC]) and cerebral blood flow was also thought to be of benefit.1,2 However, there have been concerns about potentially harmful effects of epinephrine, mediated through reduced cerebral microvascular blood flow, cardiovascular instability after ROSC and adverse metabolic and immunomodulatory effects. Recent prospective randomized trials concluded that although epinephrine generally increased the rate of ROSC, its use wasn’t associated with neurologically intact survival;3,4 findings supported by large observational studies.5–7 Of additional concern were several large database and registry studies finding that prehospital epinephrine was associated with a decreased chance of neurologically intact survival,8,9 particularly when given > 15–20 minutes after the cardiac arrest occurred, as tends to be the case in out-of-hospital cardiac arrests.10–12 Systematic reviews and meta-analyses of epinephrine in cardiac arrest reinforced concerns about the survival benefits o...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Cardiac & Resuscitation Top Story Exclusive Articles Patient Care Heart of America Source Type: news