Prehospital epinephrine use and survival among patients. Return of spontaneous circulation rosc pulse and blood pressure abrupt sustained increase in petco 2 typically. Adrenaline and vasopressin for cardiac arrest cochrane. Epinephrine in cardiac arrest in a randomized trial involving 8014 patients with outofhospital cardiac arrest, the use of epinephrine resulted in a significantly higher rate of 30day survival th. Keywords cardiac arrest advanced life support coronary perfusion pressure pulseless electrical activity favorable neurological outcome these keywords were added by machine and not. Finn j, jacobs i, williams ta, gates s, perkins gd. A randomized trial of epinephrine in outofhospital. Doses of epinephrine above 1 mg produced no incremental increase in survival to hospital discharge, even when these doses increased the rate of return of pulses. Epinephrine increases arterial blood pressure and coronary perfusion during cpr via alpha1adrenoceptor agonist effects.
About europe pmc funders joining europe pmc governance roadmap outreach. Volume 64, issue 22, 9 december 2014, pages 23602367. Rethinking the role of epinephrine in cardiac arrest. Concern about the use of epinephrine as a treatment for out ofhospital. Adrenaline and vasopressin for cardiac arrest finn, j 2019.
Cardiac arrest occurs when someones heart unexpectedly stops beating. In its current dosing strategy, epinephrine in cardiac arrest increases the chances of rosc and survival to hospital discharge, but doesnt increase neurologically intact survival. Early administration of epinephrine adrenaline in patients with. The effects of adrenaline in out of hospital cardiac arrest with. Epinephrine in outofhospital cardiac arrest 16 years, cardiac arrest from anaphylaxis or asthma, or the administration of epinephrine before the arrival of the trialtrained paramedic. Google scholar brown cg, martin dr, pepe pe, stueven h, cummins ro, gonzalez e, jastremski m. Pdf on mar 1, 2015, michael anthony smyth and others published adrenaline in cardiac arrest find, read and cite all the research you need on researchgate. Questioning the use of epinephrine to treat cardiac arrest. Epinephrine vs vasopressin vasopressin may be considered in cardiac arrest, but it offers no advantage as a substitute for epinephrine.
Vasopressin combined with epinephrine during cardiac. Kosnik jw, jackson re, keats s, tworek rm, freeman sb. Adrenaline, advanced life support, cardiac arrest, epinephrine, vasopressors. Acls cardiac arrest algorithm american heart association.
Is it time to abandon epinephrine in outofhospital cardiac arrest. When epinephrine is used concurrently with corticosteroid or ipratropium inhalations, administer bronchodilator. Participants adults in hospital who experienced cardiac arrest with an. A comparison of standarddose and highdose epinephrine in cardiac arrest outside the hospital. Is epinephrine during cardiac arrest associated with worse. Epinephrine is the primary drug administered during cardiopulmonary resuscitation cpr to reverse cardiac arrest. Epinephrine is used in the cardiac arrest algorithm as a direct iv push and also in the bradycardia algorithm as an infusion. Epinephrine is associated with increased myocardial oxygen consumption and ventricular arrhythmias during the period after resuscitation. The original data supporting the use of epinephrine for cardiac arrest is rooted in a poorly controlled canine study. The advanced cardiac life support acls recommendation that. Adrenaline, cardiac arrest, and evidence based medicine. See the respective algorithm pages for more information about their use in each.
Despite being in almost universal usage, the risks and benefits of epinephrine injected during cardiac arrest remain controversial. Epinephrine adrenaline is the most commonly used medication in cardiac arrest, and is the only drug recommended by the american heart association aha for all arrests regardless of cardiac rhythm. Epinephrine is recommended in advanced cardiac life support guidelines for use in adult cardiac arrest, and has been used in cardiopulmonary resuscitation since 1896. In adults with outofhospital cardiac arrest, the use of epinephrine. Is epinephrine during cardiac arrest associated with worse outcomes in resuscitated patients. Treatments that are proven to work in cardiac arrest include. Pdf a randomized trial of epinephrine in outofhospital cardiac. Yet, despite its long time use and incorporation into guidelines, epinephrine suffers from a paucity of evidence regarding its influence on survival.