Epinephrine in Resuscitation: Curse or Cure?

Robert R Attaran; Gordon A Ewy


Future Cardiol. 2010;6(4):473-482. 

In This Article

Future Perspective

In the future, we can look forward to the use of different and perhaps newer 'vasopressive' agents with more specific α-adrenergic or direct vasoconstricting properties without β-adrenergic effects. Equally important is the earlier administration of drugs, so the use of intraosseus drug and fluid administration will be routine.

Vasopressor drugs will be more effective with wider adoption of strategies that delay the inevitable deterioration that accompanies untreated or suboptimally treated cardiac arrest. The future will bring acceptance of CCR, a new approach to resuscitation of primary cardiac arrest that has been shown to significantly improve survival.

It has been shown that bystander resuscitation prolongs the so-called 'electrical phase' of VF arrest. The future will witness a paradigm shift in bystander CPR from mouth-to-mouth plus chest compressions to chest compressions only, thus resulting in more frequent and more effective perfusion prolonging the electrical phase of VF arrest, making defibrillation more effective.

The future will bring more effective methods of defibrillation; that is, defibrillation with minimal interruption of chest compressions. Here, perhaps, we will 'go back to the future' and return to the 1960s approach, with less reliance on automated external defibrillators and returning to the 'quick look' handheld defibrillator electrodes, where the diagnosis of VF and delivery of a shock can be executed in seconds.

Finally, the future will see the emergence of cardiac arrest centers, where patients with ROSC will be treated with early mild hypothermia therapy, early cardiac catheterization, appropriate percutaneous coronary intervention and other more effective therapies of postresuscitation syndrome.


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