High-Dose Epinephrine in Adult Cardiac Arrest

Stiell, Ian G.; Hébert, Paul C.; Weitzman, Brian; Wells, George; Raman, Sankaranarayanan; Stark, Ryan M.; Higginson, Lyall; Ahuja, Jan; Dickinson, Garth

doi:10.1056/nejm199210083271502

Cited by 344 publications

(85 citation statements)

References 40 publications

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“…Several studies in the 1990s explored even higher doses of epinephrine (3-5 mg). [138][139][140][141] Not surprisingly, most found no improvement in long-term survival. A lower epinephrine dose (<1 mg) may mitigate concerns regarding toxicity and microvascular compromise.…”

Section: Epinephrinementioning

confidence: 95%

Cardiac Arrest Resuscitation

Guyette

Reynolds

Frisch

2015

Emergency Medicine Clinics of North America

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Section: Epinephrinementioning

confidence: 95%

Cardiac Arrest Resuscitation

Guyette

Reynolds

Frisch

2015

Emergency Medicine Clinics of North America

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“…Ein mögli-cher Mechanismus, welcher für einen Teil dieser Effekte ursächlich erscheint, ist eine durch Adrenalin erzeugte signifikante Verkürzung der myokardialen Aktionspotentiale; hierdurch kann ein Kammerflimmern begünstigt oder sogar therapierefraktär fixiert werden [127]. Auch höhere Adrenalin-Dosierungen konnten das Reanimationsergebnis nicht verbessern [24,25,115]; vielmehr korrelierte eine kumulative Dosis von ≥4 mg statt 1 mg Adrenalin mit einem schlechten neurologischen Ergebnis [17]. Unter diesen Gesichtspunkten würde Adrenalin heute für die Therapie bei einer CPR nicht mehr zugelassen werden; vielmehr genießt es lediglich eine Art "Verbleiberecht" aufgrund der historischen Tradition, was die Amerikaner als "grandfather rule" bezeichnen.…”

Section: Adrenalin Oder Vasopressin Als Vasopressorunclassified

Die neuen internationalen Richtlinien zur kardiopulmonalen Reanimation

et al. 2001

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In August 2000, the American Heart Association and the European Resuscitation Council published the conclusions of the International Guidelines 2000 Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care which contains both the new recommendations and an in-depth review. The discussions and drafting began at a conference in March 1999, followed by a second conference in September 1999, both attended by approx. 250 participants and another conference in February 2000 which was attended by approx. 500 participants. Review of the current state of science, discussion and final consensus continued subsequently via email, conference calls, fax, and personal conversation. During the entire process, scientists and resuscitation councils from all over the world participated, with participants from the United States comprising approx. 60%, and scientists from outside of the United States comprising approx. 40%. In order to ensure that the CPR recomendations are not dominated by any given nation or resuscitation council, most topics were reviewed and interpretated by two scientists from the United States and two scientists from outside of the United States. Accordingly, changes in these new CPR recommendations are the result of an evidence-based review by worldwide experts. The most important changes in the recommendations according to the authors are discontinuation of the pulse-check for lay people, 500 ml instead of 800-1200 ml tidal volume during bag-valve-mask ventilation (FiO2 > 0.4) of a patient with an unprotected airway, verifying correct endotracheal intubation with capnography and an esophageal detector, employing mechanical devices such as interposed abdominal compression CPR, vest CPR, active-compression-decompression CPR, and the inspiratory threshold valve (ITV) CPR as alternatives or adjuncts to standard manual chest compressions, defibrillation with < 200 Joule biphasic instead of with 200-360 Joule monophasic impulses, vasopressin (40 units) and epinephrine (1 mg) as comparable drugs to treat patients with ventricular fibrillation, amiodarone (300 mg) for shock-refractory ventricular fibrillation and intravenous lysis for patients who have suffered a stroke.

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“…Although the initial success of cardiopulmonary resuscitation (CPR) is ‫%04ف‬ in settings of out-of-hospital cardiac arrest, a majority of these patients die within 72 hrs, primarily due to heart failure or recurrent ventricular fibrillation (VF). CPR itself therefore yields a functional survival rate of only 1.4 -5% (1)(2)(3)(4)(5)(6). Reversible myocardial dysfunction has been observed after successful resuscitation from cardiac arrest in experimental models (7)(8)(9)(10)(11) and in human patients (12).…”

mentioning

confidence: 99%