Epinephrine, the standard care in cardiac arrest in ACLS. Does it increase survival and improve neurological outcomes?
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Date
2019
Authors
Persad, Vishnu
Journal Title
Journal ISSN
Volume Title
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Abstract
Background: During cardiopulmonary resuscitation (CPR), epinephrine administered intravenously
every 3-5 minutes is the recommended drug of choice per ACLS guidelines determined by the
International Liaison Committee on Resuscitation (ILCOR), citing greater likelihood of ROSC
(1)(2)(3). However, recent evidence implies there may be impaired neurological outcomes when
administering epinephrine to cardiac arrest patients out of hospital (3)(4).
Objective: To evaluate if epinephrine has the ability to increase return of spontaneous circulation,
increase survival to discharge, and promote functional neurological outcomes in patients who
sustain an out of hospital cardiac arrest event. Furthermore, to determine whether initial cardiac
rhythms during cardiac arrest respond differently to epinephrine administration.
Methods
A literature review of randomized controlled trials was conducted using PubMed,
Google Scholar and Cochrane Library databases. Key words used include but were not limited
to: cardiac arrest, epinephrine, adrenaline, and out of hospital cardiac arrest. A total of 15 5 were
selected based on inclusion criteria.
Results: Three of the five RCTs demonstrated an increased likelihood for ROSC however there
was conflicting results as to whether epinephrine increased survival to discharge. One RCT found epinephrine administration worsened neurological outcomes. There were inconsistent
findings to discern whether different cardiac arrest rhythms respond differently to epinephrine
administration.
Conclusion: The justification of epinephrine’s use in ACLS is based on inconsistent data limited to
trials with small enrollment. Further large scale high quality RCTs are needed to determine
whether help or harm is being done to patients are in imminent danger of death.
Description
Keywords
Epinephrine, CPR, Cardiopulmonary resuscitation, Cardiac arrest