Use of pressors in the treatment of cardiac arrest

Update on cardiopulmonary resuscitation and emergency cardiovascular care guidelines

“…In this hypoxic and acidotic state, adrenergic receptors become less sensitive to the vasoconstrictive effects of epinephrine and other catecholamines. 56,57 Vasopressin continues to cause vasoconstriction in the presence of acidosis. [62][63][64][65][66] In addition, studies have shown that increased epinephrine levels after cardiac arrest are associated with increased mortality, while increased levels of vasopressin are associated with improved survival.…”

“…54,55 Although historically and currently recommended for use in cardiac arrest, epinephrine, either in high or low dosages, has never been shown in a placebocontrolled trial to improve survival to hospital discharge. [56][57][58][59][60][61] Due to its lack of proven efficacy and concerns about its adverse effects (e.g., severe hypertension, myocardial ischemia, intractable ventricular tachydysrhythmias), high-dose epinephrine is no longer recommended, and new vasopressors for cardiac arrest are being investigated. 56,57 Vasopressin is an endogenous hormone that causes profound vasoconstriction when given in supraphysiological doses.…”

“…[56][57][58][59][60][61] Due to its lack of proven efficacy and concerns about its adverse effects (e.g., severe hypertension, myocardial ischemia, intractable ventricular tachydysrhythmias), high-dose epinephrine is no longer recommended, and new vasopressors for cardiac arrest are being investigated. 56,57 Vasopressin is an endogenous hormone that causes profound vasoconstriction when given in supraphysiological doses. It has the theoretical advantage over epinephrine of increasing oxygen delivery to vital organs without increasing oxygen consumption and worsening ischemia.…”

Vasopressors for cardiopulmonary resuscitation

“…Aortic diastolic pressure, an important determinant of coronary blood-flow is increased (Michael et al 1984;Brown and Werman 1990). Maintenance of coronary blood-flow is the most important factor in enabling return of spontaneous circulation (ROSC) or successful defibrillation (Kern et al 1988;Paradis et al 1990;Paradis et al 1991;Babbs et al 2001;Zhong and Dorian 2005) It is interesting to note that one historical resuscitation method was to throw cold water at the face of the victim. (Hermreck 1988).…”

III Diretriz sobre tratamento do infarto agudo do miocárdio

“…Pode ser usada como alternativa à epinefrina no tratamento de fibrilação ventricular refratária à desfibrilação no adulto. A dose é de 40 U por via endovenosa em dose única 593,647,648 .…”