Epinephrine in Resuscitation: Curse or Cure?

Robert R Attaran; Gordon A Ewy

Disclosures

Future Cardiol. 2010;6(4):473-482. 

In This Article

Conclusion

Epinephrine can be either a curse or a cure when used as an adjunct to resuscitation of cardiac arrest. Its value depends on the dosage given, the timing of administration and the initiating factor of the cardiac arrest. Epinephrine can be a curse in excessive doses or if used too late in resuscitation efforts, resulting in ROSC without improved (and neurologically intact) survival.

Epinephrine's use is based on decades of efficacy in animal models, despite a lack of definitive evidence in clinical trials. There are two major reasons for the disparity between models. The first relates to the timing of its administration. On average, epinephrine has been administered nearly 10 min earlier in the experimental laboratory. The second reason may be that in animal studies, the cause of the VF is often different. If the initiating factor (i.e., the electrical current that initiated the VF in the animal model) is no longer present, epinephrine given early clearly improves survival. In humans, the cause of the VF arrest may be coronary occlusion, thus even after defibrillation the initiating factor is still present, resulting in recurrent VF. In this situation, repeated doses of epinephrine contribute to the electrical storm. Accordingly, the concomitant use of vasopressin and the addition of β-adrenergic blockers to epinephrine may well be needed to improved survival.

But even if epinephrine can be administered earlier in patients with OHCA via intraosseus administration, this by itself is not a cure. Epinephrine is but one of many interventions that need to be appropriately integrated into the series of essential steps of advanced cardiac life support for optimal resuscitation of patients with OHCA. Many of these features have been integrated into CCR.

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