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Review
. 2018 May 29;22(1):139.
doi: 10.1186/s13054-018-2058-1.

The role of adrenaline in cardiopulmonary resuscitation

Christopher J R Gough  1 , Jerry P Nolan  2   3
Affiliations
Review

The role of adrenaline in cardiopulmonary resuscitation

Christopher J R Gough et al. Crit Care. .

Abstract

Adrenaline has been used in the treatment of cardiac arrest for many years. It increases the likelihood of return of spontaneous circulation (ROSC), but some studies have shown that it impairs cerebral microcirculatory flow. It is possible that better short-term survival comes at the cost of worse long-term outcomes. This narrative review summarises the rationale for using adrenaline, significant studies to date, and ongoing research.

Keywords: Adrenaline; Cardiac arrest; Cardiopulmonary resuscitation; Epinephrine; Outcome.

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Conflict of interest statement

Competing interests

CJRG declares no competing interests. JPN is a co-investigator for the National Institute of Health Research (NIHR) funded PARAMEDIC-2 trial and is Editor-in-Chief of the journal Resuscitation.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Forrest plot comparing ROSC for those who did, and did not, receive adrenaline (epinephrine)
Fig. 2
Fig. 2
Forrest plot comparing favourable neurological outcome (CPC 1–2) for those who did, and did not, receive adrenaline (epinephrine)
Fig. 3
Fig. 3
Forrest plot comparing ROSC for those who received high-dose adrenaline (HDA) compared with standard dose adrenaline (SDA)
Fig. 4
Fig. 4
Forrest plot comparing survival to hospital discharge for those who received high-dose adrenaline (HDA) compared with standard dose adrenaline (SDA)
See this image and copyright information in PMC

Comment in

References

    1. Paradis NA, Martin GB, Rivers EP, et al. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA. 1990;263:1106–1113. doi: 10.1001/jama.1990.03440080084029. - DOI - PubMed
    1. Hardig BM, Gotberg M, Rundgren M, et al. Physiologic effect of repeated adrenaline (epinephrine) doses during cardiopulmonary resuscitation in the cath lab setting: A randomised porcine study. Resuscitation. 2016;101:77–83. doi: 10.1016/j.resuscitation.2016.01.032. - DOI - PubMed
    1. Burnett AM, Segal N, Salzman JG, McKnite MS, Frascone RJ. Potential negative effects of epinephrine on carotid blood flow and ETCO2 during active compression-decompression CPR utilizing an impedance threshold device. Resuscitation. 2012;83:1021–1024. doi: 10.1016/j.resuscitation.2012.03.018. - DOI - PubMed
    1. Ristagno G, Sun S, Tang W, Castillo C, Weil MH. Effects of epinephrine and vasopressin on cerebral microcirculatory flows during and after cardiopulmonary resuscitation. Crit Care Med. 2007;35:2145–2149. doi: 10.1097/01.CCM.0000280427.76175.D2. - DOI - PubMed
    1. Ristagno G, Tang W, Huang L, et al. Epinephrine reduces cerebral perfusion during cardiopulmonary resuscitation. Crit Care Med. 2009;37:1408–1415. doi: 10.1097/CCM.0b013e31819cedc9. - DOI - PubMed

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