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Epinephrine in cardiac arrest – the good, the bad, and the ugly

The available clinical data confirm that epinephrine administration during cardiopulmonary resuscitation (CPR) can increase short-term survival, but with either no benefit or even harm for outcomes such as long-term survival or functional recovery, according to a study1 published recently in Current Opinion in Cardiology.

In one of the studies reviewed, 851 adult, out-of hospital cardiac arrest patients were randomly allocated to have intravenous drugs versus no intravenous drugs during CPR. Patients with an intravenous line had a higher rate of return of pulses (40% versus 25%) and admission to the intensive care unit (ICU) (30% versus 20%). However, the proportion discharged from the hospital or alive at one year did not differ. The most common intravenous drug administered was epinephrine (79% of patients).

Another study reviewed compared survival when 535 adult, out-of-hospital cardiac arrest patients received either standard 1 mg boluses of epinephrine or placebo. Patients who received epinephrine had higher rates of return of pulses (30% versus 11%) and admission to the hospital (25% versus 13%). However, the proportion discharged from the hospital (4.1% versus 1.9%) or with a favourable recovery (3.3% versus 1.9%) did not differ.

Laboratory data suggest that harmful epinephrine-induced reductions in microvascular blood flow during and after CPR may offset the beneficial epinephrine-induced increase in arterial blood pressure during CPR, the authors say. Prospective trials are needed to determine the correct dose, timing and patients for epinephrine in cardiac arrest, they conclude.


1. Callaway CW. Epinephrine for cardiac arrest. Curr Opin in Cardiol 2013;28:36–42.

Published on: February 28, 2013

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