From the Research
Intracardiac epinephrine administration is no longer recommended in modern resuscitation protocols due to its significant risks and the availability of safer alternatives. This route has been abandoned in favor of intravenous (IV) or intraosseous (IO) epinephrine administration during cardiac arrest situations, as supported by recent studies such as 1. If IV/IO access cannot be established, the preferred alternative is endotracheal administration at 2-2.5 times the standard IV dose (typically 1 mg IV becomes 2-2.5 mg endotracheally).
Some key points to consider when administering epinephrine in cardiac arrest situations include:
- The American Heart Association recommends epinephrine may be reasonable in patients with cardiac arrest, as part of Advanced Cardiac Life Support, but the literature behind its use is not strong 1.
- High-dose epinephrine is harmful and is not recommended 1.
- Epinephrine may improve return of spontaneous circulation, but does not improve survival to discharge or neurologic outcome 1, 2.
- The timing of epinephrine may affect patient outcome, but Basic Life Support measures are the most important aspect of resuscitation and patient survival 1.
- Modern advanced cardiac life support (ACLS) focuses on high-quality chest compressions with minimal interruptions, early defibrillation when indicated, and administration of epinephrine through established IV/IO routes at 1 mg every 3-5 minutes during cardiac arrest.
Intracardiac injection carries significant risks including coronary artery laceration, myocardial laceration, pneumothorax, and cardiac tamponade. Additionally, it requires interruption of chest compressions, which reduces perfusion and decreases survival chances. The procedure is technically challenging, especially in emergency situations, and the theoretical benefit of direct cardiac delivery is outweighed by these risks and the availability of safer alternatives. Recent studies, such as 3, have also shown that the use of epinephrine before defibrillation is associated with worse survival outcomes, highlighting the importance of following established guidelines and protocols.