What clinical literature supports the use of V (medication)?

Clinical Literature Supporting Vasopressors in Cardiac Arrest

Vasopressors, particularly adrenaline (epinephrine) and vasopressin, are recommended for use in cardiac arrest based on their ability to improve myocardial and cerebral blood flow during resuscitation. 1

Adrenaline (Epinephrine)

• Standard dosing of adrenaline is 1 mg administered intravenously every 3 minutes during cardiac arrest resuscitation 1
• Experimentally, adrenaline improves myocardial and cerebral blood flow and resuscitation rates in animals 1
• Despite the lack of unequivocal clinical evidence showing improved survival or neurological recovery in humans, adrenaline remains a cornerstone of resuscitation protocols due to its ability to increase rates of spontaneous circulation 1
• Caution should be exercised when administering adrenaline in patients whose arrest is associated with solvent abuse, cocaine, and other sympathomimetic drugs 1

Vasopressin

• Vasopressin (40U) is accepted as a possible alternative to adrenaline in cardiac arrest 1
• Experimental evidence shows that vasopressin leads to significantly higher coronary perfusion pressures compared to standard treatments 1

Administration Routes

• Central venous access is the optimal route for delivering vasopressors rapidly into central circulation 1
• Peripheral venous cannulation is often quicker, easier, and safer to perform, but should be followed by a flush of 10–20 ml of 0.9% saline 1
• When venous access is not available, adrenaline can be administered via the tracheal tube at higher doses (2–3 times standard) diluted in 10 ml of sterile water 1

Clinical Context and Timing

• Vasopressors are typically administered after initial defibrillation attempts in shockable rhythms (VF/VT) or early in the algorithm for non-shockable rhythms (asystole/PEA) 1
• They are used in conjunction with other resuscitation measures including chest compressions, ventilation, and when appropriate, defibrillation 1

Limitations and Considerations

• The evidence supporting vasopressor use in cardiac arrest is primarily based on their physiological effects rather than demonstrated improvements in long-term survival 1
• No agent has been found that definitively improves survival to hospital discharge rates 1
• Vasopressors should be considered as part of a comprehensive resuscitation approach rather than as isolated interventions 1

Antiarrhythmic Agents Used in Conjunction with Vasopressors

• Amiodarone is the first-choice antiarrhythmic agent in patients with VF/VT refractory to 3 initial shocks 1
• Initial dosing is 300 mg IV diluted in 20 ml 5% dextrose as a bolus, with an additional 150 mg IV dose if VF/VT recurs 1
• Magnesium (8 mmol) is recommended for refractory VF if hypomagnesemia is suspected 1
• Lidocaine and procainamide are alternatives if amiodarone is not available but should not be given in addition to amiodarone 1

The clinical literature supporting vasopressors in cardiac arrest is primarily based on their physiological effects on coronary and cerebral perfusion rather than definitive evidence of improved long-term outcomes. Nevertheless, they remain a critical component of current resuscitation algorithms.