Epinephrine in Resuscitation: Curse or Cure?

Robert R Attaran; Gordon A Ewy


Future Cardiol. 2010;6(4):473-482. 

In This Article

Abstract and Introduction


The use of epinephrine during cardiac arrest has been advocated for decades and forms an integral part of the published guidelines. Its efficacy is supported by animal data, but human trial evidence is lacking. This is partly attributable to disparities in trial methodology. Epinephrine's pharmacologic and physiologic effects include an increase in coronary perfusion pressure that is key to successful resuscitation. One possible explanation for the lack of epinephrine's demonstrated efficacy in human trials of out-of-hospital cardiac arrest is the delay in its administration. A potential solution may be intraosseus epinephrine, which can be administered quicker. More importantly, it is the quality of the basic life support, early and uninterrupted chest compressions, early defibrillation and postresuscitation care that will provide the best chance of neurologically intact survival.


Epinephrine administration has been advocated during resuscitation of cardiac arrest for decades.[1–5] The 2005 guidelines by both the American Heart Association and the European Resuscitation Council recommend its use.[6–8] Surprisingly, definitive evidence for epinephrine's efficacy in humans is lacking. As with many components of the Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care, its recommendation is largely based on tradition and its success in animal models. Conflicting results between animal and human research are due to the disparate methodology and populations studied, as well as the duration of untreated and treated cardiac arrest prior to epinephrine administration. The purpose of this article is to review the pertinent literature and to provide our perspective on the present role of epinephrine in resuscitation of out-of-hospital cardiac arrest (OHCA), with emphasis on primary cardiac arrests owing to ventricular fibrillation (VF). This perspective is influenced by the senior author's extensive experience with epinephrine use during experimental and clinical resuscitation studies of subjects with primary cardiac arrest.


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