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:10.1097/00132586-199404000-00063

Cited by 20 publications

(18 citation statements)

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“…As with other human studies of vasopressors, this may be related to the late administration of these vasoactive drugs. Down-times exceeding 10 min are known to confer low ROSC rates [64].…”

Section: Epinephrine Versus Other Vasopressors: Animal and Human Studiesmentioning

confidence: 99%

Epinephrine in Resuscitation: Curse or Cure?

Attaran

Ewy

2010

Future Cardiol.

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The use of epinephrine during cardiac arrest has been advocated for decades and forms an integral part of the published guidelines. Its efficacy is supported by animal data, but human trial evidence is lacking. This is partly attributable to disparities in trial methodology. Epinephrine’s pharmacologic and physiologic effects include an increase in coronary perfusion pressure that is key to successful resuscitation. One possible explanation for the lack of epinephrine’s demonstrated efficacy in human trials of out-of-hospital cardiac arrest is the delay in its administration. A potential solution may be intraosseus epinephrine, which can be administered quicker. More importantly, it is the quality of the basic life support, early and uninterrupted chest compressions, early defibrillation and postresuscitation care that will provide the best chance of neurologically intact survival.

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“…As with other human studies of vasopressors, this may be related to the late administration of these vasoactive drugs. Down-times exceeding 10 min are known to confer low ROSC rates [64].…”

Section: Epinephrine Versus Other Vasopressors: Animal and Human Studiesmentioning

confidence: 99%

Epinephrine in Resuscitation: Curse or Cure?

Attaran

Ewy

2010

Future Cardiol.

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“…For instance, it seems likely that different requirements might apply when resuscitation takes place within a hospital (and access to a physician is presumably rapid) and out-of hospital resuscitation when there may be a delay in obtaining medical assistance. Of interest, one clinical trial including 650 patients noted poor rates of survival when a high dose of adrenaline was given later than 10 minutes after cardiac arrest (Stiell et al 1992). Further analysis of time-course data is required to determine the significance of such observations.…”

Section: Time Course Of Cardiac Arrestmentioning

confidence: 99%

Vasopressors for cardiopulmonary resuscitation

Penson

Ford

Broadley

2007

Pharmacology & Therapeutics

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“…56 57 Some clinical trials have reported slightly increased rates of return of spontaneous circulation with high doses of adrenaline/epinephrine but without improvement in overall survival rate. [58][59][60][61][62] The reasons for the difference between experimental and clinical results are likely to reflect differences in underlying pathology and the relatively long periods of arrest before the advanced life support team is able to give adrenaline/ epinephrine outside hospital. It is also possible that higher doses of adrenaline/epinephrine may be detrimental in the post-resuscitation period.…”

Section: Vasopressorsmentioning

confidence: 99%