Epinephrine in Resuscitation: Curse or Cure?

Robert R Attaran; Gordon A Ewy


Future Cardiol. 2010;6(4):473-482. 

In This Article

Intraosseous Administration of Epinephrine

Animal studies clearly show that the early administration of vasopressor drugs in prolonged VF cardiac arrest may be crucial to achieving adequate perfusion pressures to vital organs, thereby improving the likelihood for successful defibrillation and good neurological outcome. However, placing an intravenous line in patients during cardiac arrest while CPR is being performed is difficult and sometimes not possible. A systematic review of studies between 1990 and 2005 found that in humans the time to first drug administration from the time of dispatch ranged from 10 to 25 min (mean: 17.7 min).[76] This is significantly longer than administration times in animal studies where drugs are frequently given in under 10 min.[77–79] Reynolds et al. found a mean time of 9.5 min to first drug administration in animal CPR models compared with the 19.4 min reported in human clinical trials.[80]

One approach to earlier administration of epinephrine during OHCA is via the intraosseous route, as this can be performed quickly in the field. In our laboratory, Zuercher et al. recently found that the time from injection to peak coronary perfusion pressure attainment was only slightly slower in the intraosseus group compared with the intravenous group, but the hemodynamic effects were similar [Ewy GA, Personal Communication]. In this study, where intraosseus epinephrine was administered 6 min earlier than intravenous epinephrine, Zuercher et al. found a reduced number of required shocks, less time to ROSC and a favorable neurological outcome with early intraosseus compared with later intravenous epinephrine. For these reasons, intraosseous epinephrine is recommended.


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