Epinephrine in Resuscitation: Curse or Cure?

Robert R Attaran; Gordon A Ewy

Disclosures

Future Cardiol. 2010;6(4):473-482. 

In This Article

Deleterious Effects of Multiple-dose Epinephrine

Having recommended epinephrine, a caveat must be added. As noted previously, epinephrine may not be the ideal vasopressor to use during resuscitation of cardiac arrest, as it is the α- or vasoconstrictive effects of epinephrine that are beneficial, while its β-effects may be detrimental. Clinical experience with more effective approaches to resuscitation of OHCA has resulted in better survival,[81] but also a higher incidence of recurrent VF during resuscitation efforts. This may be due to the excessive β-adrenergic effects of epinephrine. For example, it is known, that the preferred treatment of 'electrical storm' is β-adrenergic blockade.[82] Future studies in humans should evaluate alternatives such as epinephrine plus β-blockers or a single dose of epinephrine followed by a single dose of vasopressin to decrease the number of subsequent doses of epinephrine required. The use of pure α-adrenergic drugs such as vasopressors has been shown to be effective in animals and needs to be studied in humans. However, the use of epinephrine is so engrained in the current guidelines that it would take compelling evidence to remove it, evidence that to this day does not exist.

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