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Published in: Critical Care 1/2018

Open Access 01-12-2018 | Review

The role of adrenaline in cardiopulmonary resuscitation

Authors: Christopher J. R. Gough, Jerry P. Nolan

Published in: Critical Care | Issue 1/2018

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Abstract

Adrenaline has been used in the treatment of cardiac arrest for many years. It increases the likelihood of return of spontaneous circulation (ROSC), but some studies have shown that it impairs cerebral microcirculatory flow. It is possible that better short-term survival comes at the cost of worse long-term outcomes. This narrative review summarises the rationale for using adrenaline, significant studies to date, and ongoing research.
Literature
1.
go back to reference Paradis NA, Martin GB, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA. 1990;263:1106–13.CrossRefPubMed Paradis NA, Martin GB, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA. 1990;263:1106–13.CrossRefPubMed
2.
go back to reference Hardig BM, Gotberg M, Rundgren M, et al. Physiologic effect of repeated adrenaline (epinephrine) doses during cardiopulmonary resuscitation in the cath lab setting: A randomised porcine study. Resuscitation. 2016;101:77–83.CrossRefPubMed Hardig BM, Gotberg M, Rundgren M, et al. Physiologic effect of repeated adrenaline (epinephrine) doses during cardiopulmonary resuscitation in the cath lab setting: A randomised porcine study. Resuscitation. 2016;101:77–83.CrossRefPubMed
3.
go back to reference Burnett AM, Segal N, Salzman JG, McKnite MS, Frascone RJ. Potential negative effects of epinephrine on carotid blood flow and ETCO2 during active compression-decompression CPR utilizing an impedance threshold device. Resuscitation. 2012;83:1021–4.CrossRefPubMed Burnett AM, Segal N, Salzman JG, McKnite MS, Frascone RJ. Potential negative effects of epinephrine on carotid blood flow and ETCO2 during active compression-decompression CPR utilizing an impedance threshold device. Resuscitation. 2012;83:1021–4.CrossRefPubMed
4.
go back to reference Ristagno G, Sun S, Tang W, Castillo C, Weil MH. Effects of epinephrine and vasopressin on cerebral microcirculatory flows during and after cardiopulmonary resuscitation. Crit Care Med. 2007;35:2145–9.CrossRefPubMed Ristagno G, Sun S, Tang W, Castillo C, Weil MH. Effects of epinephrine and vasopressin on cerebral microcirculatory flows during and after cardiopulmonary resuscitation. Crit Care Med. 2007;35:2145–9.CrossRefPubMed
5.
go back to reference Ristagno G, Tang W, Huang L, et al. Epinephrine reduces cerebral perfusion during cardiopulmonary resuscitation. Crit Care Med. 2009;37:1408–15.CrossRefPubMed Ristagno G, Tang W, Huang L, et al. Epinephrine reduces cerebral perfusion during cardiopulmonary resuscitation. Crit Care Med. 2009;37:1408–15.CrossRefPubMed
6.
go back to reference Fries M, Weil MH, Chang YT, Castillo C, Tang W. Microcirculation during cardiac arrest and resuscitation. Crit Care Med. 2006;34:S454–7.CrossRefPubMed Fries M, Weil MH, Chang YT, Castillo C, Tang W. Microcirculation during cardiac arrest and resuscitation. Crit Care Med. 2006;34:S454–7.CrossRefPubMed
7.
go back to reference Halvorsen P, Sharma HS, Basu S, Wiklund L. Neural injury after use of vasopressin and adrenaline during porcine cardiopulmonary resuscitation. Ups J Med Sci. 2015;120:11–9.CrossRefPubMedPubMedCentral Halvorsen P, Sharma HS, Basu S, Wiklund L. Neural injury after use of vasopressin and adrenaline during porcine cardiopulmonary resuscitation. Ups J Med Sci. 2015;120:11–9.CrossRefPubMedPubMedCentral
8.
go back to reference Ditchey RV, Lindenfeld J. Failure of epinephrine to improve the balance between myocardial oxygen supply and demand during closed-chest resuscitation in dogs. Circulation. 1988;78:382–9.CrossRefPubMed Ditchey RV, Lindenfeld J. Failure of epinephrine to improve the balance between myocardial oxygen supply and demand during closed-chest resuscitation in dogs. Circulation. 1988;78:382–9.CrossRefPubMed
9.
go back to reference Johansson J, Gedeborg R, Basu S, Rubertsson S. Increased cortical cerebral blood flow by continuous infusion of adrenaline (epinephrine) during experimental cardiopulmonary resuscitation. Resuscitation. 2003;57:299–307.CrossRefPubMed Johansson J, Gedeborg R, Basu S, Rubertsson S. Increased cortical cerebral blood flow by continuous infusion of adrenaline (epinephrine) during experimental cardiopulmonary resuscitation. Resuscitation. 2003;57:299–307.CrossRefPubMed
10.
go back to reference Deakin CD, Yang J, Nguyen R, et al. Effects of epinephrine on cerebral oxygenation during cardiopulmonary resuscitation: a prospective cohort study. Resuscitation. 2016;109:138–44.CrossRefPubMed Deakin CD, Yang J, Nguyen R, et al. Effects of epinephrine on cerebral oxygenation during cardiopulmonary resuscitation: a prospective cohort study. Resuscitation. 2016;109:138–44.CrossRefPubMed
11.
go back to reference Putzer G, Braun P, Strapazzon G, et al. Monitoring of brain oxygenation during hypothermic CPR - a prospective porcine study. Resuscitation. 2016;104:1–5.CrossRefPubMed Putzer G, Braun P, Strapazzon G, et al. Monitoring of brain oxygenation during hypothermic CPR - a prospective porcine study. Resuscitation. 2016;104:1–5.CrossRefPubMed
12.
go back to reference Nordseth T, Olasveengen TM, Kvaloy JT, Wik L, Steen PA, Skogvoll E. Dynamic effects of adrenaline (epinephrine) in out-of-hospital cardiac arrest with initial pulseless electrical activity (PEA). Resuscitation. 2012;83:946–52.CrossRefPubMed Nordseth T, Olasveengen TM, Kvaloy JT, Wik L, Steen PA, Skogvoll E. Dynamic effects of adrenaline (epinephrine) in out-of-hospital cardiac arrest with initial pulseless electrical activity (PEA). Resuscitation. 2012;83:946–52.CrossRefPubMed
14.
go back to reference Andersen LW, Kurth T. Propensity scores - a brief introduction for resuscitation researchers. Resuscitation. 2018;125:66–9.CrossRefPubMed Andersen LW, Kurth T. Propensity scores - a brief introduction for resuscitation researchers. Resuscitation. 2018;125:66–9.CrossRefPubMed
15.
go back to reference Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S. Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA. 2012;307:1161–8.CrossRefPubMed Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S. Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA. 2012;307:1161–8.CrossRefPubMed
16.
go back to reference Nakahara S, Tomio J, Takahashi H, et al. Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study. BMJ. 2013;347:f6829.CrossRefPubMedPubMedCentral Nakahara S, Tomio J, Takahashi H, et al. Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study. BMJ. 2013;347:f6829.CrossRefPubMedPubMedCentral
17.
go back to reference Andersen LW, Grossestreuer AV, Donnino MW. “Resuscitation time bias”--a unique challenge for observational cardiac arrest research. Resuscitation. 2018;125:79–82.CrossRefPubMedPubMedCentral Andersen LW, Grossestreuer AV, Donnino MW. “Resuscitation time bias”--a unique challenge for observational cardiac arrest research. Resuscitation. 2018;125:79–82.CrossRefPubMedPubMedCentral
18.
go back to reference Goto Y, Maeda T, Goto Y. Effects of prehospital epinephrine during out-of-hospital cardiac arrest with initial non-shockable rhythm: an observational cohort study. Crit Care. 2013;17:R188.CrossRefPubMedPubMedCentral Goto Y, Maeda T, Goto Y. Effects of prehospital epinephrine during out-of-hospital cardiac arrest with initial non-shockable rhythm: an observational cohort study. Crit Care. 2013;17:R188.CrossRefPubMedPubMedCentral
19.
go back to reference Dumas F, Bougouin W, Geri G, et al. Is epinephrine during cardiac arrest associated with worse outcomes in resuscitated patients? J Am Coll Cardiol. 2014;64:2360–7.CrossRefPubMed Dumas F, Bougouin W, Geri G, et al. Is epinephrine during cardiac arrest associated with worse outcomes in resuscitated patients? J Am Coll Cardiol. 2014;64:2360–7.CrossRefPubMed
20.
go back to reference Stiell IG, Wells GA, Field B, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med. 2004;351:647–56.CrossRefPubMed Stiell IG, Wells GA, Field B, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med. 2004;351:647–56.CrossRefPubMed
21.
go back to reference Loomba RS, Nijhawan K, Aggarwal S, Arora RR. Increased return of spontaneous circulation at the expense of neurologic outcomes: Is prehospital epinephrine for out-of-hospital cardiac arrest really worth it? J Crit Care. 2015;30:1376–81.CrossRefPubMed Loomba RS, Nijhawan K, Aggarwal S, Arora RR. Increased return of spontaneous circulation at the expense of neurologic outcomes: Is prehospital epinephrine for out-of-hospital cardiac arrest really worth it? J Crit Care. 2015;30:1376–81.CrossRefPubMed
22.
go back to reference Donnino MW, Salciccioli JD, Howell MD, et al. Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry. BMJ. 2014;348:g3028.CrossRefPubMedPubMedCentral Donnino MW, Salciccioli JD, Howell MD, et al. Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry. BMJ. 2014;348:g3028.CrossRefPubMedPubMedCentral
23.
go back to reference Andersen LW, Kurth T, Chase M, et al. Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis. BMJ. 2016;353:i1577.CrossRefPubMedPubMedCentral Andersen LW, Kurth T, Chase M, et al. Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis. BMJ. 2016;353:i1577.CrossRefPubMedPubMedCentral
24.
25.
go back to reference Tanaka H, Takyu H, Sagisaka R, et al. Favorable neurological outcomes by early epinephrine administration within 19 minutes after EMS call for out-of-hospital cardiac arrest patients. Am J Emerg Med. 2016;34:2284–90.CrossRefPubMed Tanaka H, Takyu H, Sagisaka R, et al. Favorable neurological outcomes by early epinephrine administration within 19 minutes after EMS call for out-of-hospital cardiac arrest patients. Am J Emerg Med. 2016;34:2284–90.CrossRefPubMed
26.
go back to reference Rittenberger JC, Bost JE, Menegazzi JJ. Time to give the first medication during resuscitation in out-of-hospital cardiac arrest. Resuscitation. 2006;70:201–6.CrossRefPubMed Rittenberger JC, Bost JE, Menegazzi JJ. Time to give the first medication during resuscitation in out-of-hospital cardiac arrest. Resuscitation. 2006;70:201–6.CrossRefPubMed
27.
go back to reference Koscik C, Pinawin A, McGovern H, et al. Rapid epinephrine administration improves early outcomes in out-of-hospital cardiac arrest. Resuscitation. 2013;84:915–20.CrossRefPubMed Koscik C, Pinawin A, McGovern H, et al. Rapid epinephrine administration improves early outcomes in out-of-hospital cardiac arrest. Resuscitation. 2013;84:915–20.CrossRefPubMed
28.
go back to reference Lin S, Callaway CW, Shah PS, et al. Adrenaline for out-of-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomized controlled trials. Resuscitation. 2014;85:732–40.CrossRefPubMed Lin S, Callaway CW, Shah PS, et al. Adrenaline for out-of-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomized controlled trials. Resuscitation. 2014;85:732–40.CrossRefPubMed
29.
go back to reference Fisk CA, Olsufka M, Yin L, et al. Lower-dose epinephrine administration and out-of-hospital cardiac arrest outcomes. Resuscitation. 2018;124:43–8.CrossRefPubMed Fisk CA, Olsufka M, Yin L, et al. Lower-dose epinephrine administration and out-of-hospital cardiac arrest outcomes. Resuscitation. 2018;124:43–8.CrossRefPubMed
30.
go back to reference Warren SA, Huszti E, Bradley SM, et al. Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: a retrospective review of prospectively collected data. Resuscitation. 2014;85:350–8.CrossRefPubMed Warren SA, Huszti E, Bradley SM, et al. Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: a retrospective review of prospectively collected data. Resuscitation. 2014;85:350–8.CrossRefPubMed
31.
go back to reference Wang CH, Huang CH, Chang WT, et al. The influences of adrenaline dosing frequency and dosage on outcomes of adult in-hospital cardiac arrest: A retrospective cohort study. Resuscitation. 2016;103:125–30.CrossRefPubMed Wang CH, Huang CH, Chang WT, et al. The influences of adrenaline dosing frequency and dosage on outcomes of adult in-hospital cardiac arrest: A retrospective cohort study. Resuscitation. 2016;103:125–30.CrossRefPubMed
32.
go back to reference Hoyme DB, Patel SS, Samson RA, et al. Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest. Resuscitation. 2017;117:18–23.CrossRefPubMed Hoyme DB, Patel SS, Samson RA, et al. Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest. Resuscitation. 2017;117:18–23.CrossRefPubMed
33.
go back to reference Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L. Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA. 2009;302:2222–9.CrossRefPubMed Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, Wik L. Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA. 2009;302:2222–9.CrossRefPubMed
34.
go back to reference Olasveengen TM, Wik L, Sunde K, Steen PA. Outcome when adrenaline (epinephrine) was actually given vs. not given - post hoc analysis of a randomized clinical trial. Resuscitation. 2012;83:327–32.CrossRefPubMed Olasveengen TM, Wik L, Sunde K, Steen PA. Outcome when adrenaline (epinephrine) was actually given vs. not given - post hoc analysis of a randomized clinical trial. Resuscitation. 2012;83:327–32.CrossRefPubMed
35.
go back to reference Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL. Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial. Resuscitation. 2011;82:1138–43.CrossRefPubMed Jacobs IG, Finn JC, Jelinek GA, Oxer HF, Thompson PL. Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial. Resuscitation. 2011;82:1138–43.CrossRefPubMed
36.
go back to reference Perkins GD, Quinn T, Deakin CD, et al. Pre-hospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug administration In Cardiac arrest (PARAMEDIC-2): trial protocol. Resuscitation. 2016;108:75–81.CrossRefPubMedPubMedCentral Perkins GD, Quinn T, Deakin CD, et al. Pre-hospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug administration In Cardiac arrest (PARAMEDIC-2): trial protocol. Resuscitation. 2016;108:75–81.CrossRefPubMedPubMedCentral
Metadata
Title
The role of adrenaline in cardiopulmonary resuscitation
Authors
Christopher J. R. Gough
Jerry P. Nolan
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2058-1

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