Epinephrine in Resuscitation: Curse or Cure?

Robert R Attaran; Gordon A Ewy


Future Cardiol. 2010;6(4):473-482. 

In This Article

Historical Considerations

In 1874, Pellacani became perhaps the first to administer adrenal extract to animals.[9] The extract was found to increase arterial tone, ventricular contractions and blood pressure. In 1896, after inducing profound hypotension, Gottlieb restored circulation by administering adrenal extract.[10]

As early as 1906, Crile and Dolley noted the importance of an adequate aortic diastolic pressure during attempted cardiac resuscitation.[11] They stated that it often was not possible to achieve an adequate aortic diastolic pressure without the addition of epinephrine.

Since epinephrine has both inotropic and chronotropic effects on the beating heart and also produces peripheral vasoconstriction, there was confusion regarding which of these effects was the most important. Epinephrine increases the peripheral vascular resistance, transiently decreasing perfusion to most of the body, but in the process increases the aortic diastolic pressure and perfusion to the heart.

The classic studies of Pearson and Redding performed in the 1960s merit emphasis.[12–14] After induction of asphyxial cardiac arrest, chest compressions and ventilations resulted in survival of none of the ten animals that received isoproterenol, all of the animals that received epinephrine and nine of the ten animals that received the α-agonist methoxamine. In a similar study following VF induction, survival was one out of ten without drugs, nine out of ten with epinephrine and ten out of ten with the α-agonist phenylephrine. In the 1970s, a re-examination of this phenomenon found that α-adrenergic blockade administered with epinephrine prevented resuscitation in animals with cardiac arrest. However, resuscitation of animals with β-adrenergic blockade administered with epinephrine, however, was uniformly successful.[15] Early on it was concluded that drugs that have their principal effect by cardiac stimulation, such as isoproterenol or dobutamine, did not help during cardiac arrest. Drugs that were potent peripheral vasoconstrictors, such as phenylephrine, methoxamine or dopamine, were as effective as epinephrine during cardiopulmonary resuscitation (CPR).


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