What is the role of administering epinephrine (adrenaline) in Cardiopulmonary Resuscitation (CPR)?

From the Guidelines

Role of Epinephrine in Cardiopulmonary Resuscitation (CPR)

The administration of epinephrine (adrenaline) in cardiopulmonary resuscitation (CPR) is a standard treatment for cardiac arrest.

• The dose of epinephrine is 1 mg (10 mL of 1:10,000 solution) administered intravenously or intraosseously, repeated every 3-5 minutes as needed 1.
• The American Heart Association recommends that epinephrine be given as soon as possible after the onset of cardiac arrest, ideally after two minutes of CPR, and continued until return of spontaneous circulation or termination of resuscitation efforts.
• Key benefits of epinephrine administration include increased survival to hospital discharge and return of spontaneous circulation (ROSC), although there is no significant difference in survival to hospital discharge with a favorable neurological outcome 1.
• The use of epinephrine has been shown to increase survival at 30 days and may have a positive effect on neurological outcomes at 3 months, although more research is needed to confirm these findings 1.
• Operationally, administering epinephrine every second cycle of CPR after the initial dose may also be reasonable 1.
• It is essential to note that the timing of epinephrine administration is crucial, with earlier administration associated with improved outcomes in patients with nonshockable rhythms 1.

From the Research

Role of Epinephrine in Cardiopulmonary Resuscitation (CPR)

The administration of epinephrine (adrenaline) plays a crucial role in Cardiopulmonary Resuscitation (CPR). The key aspects of epinephrine administration in CPR are:

• Dosage: The optimal dosage of epinephrine is still a topic of debate. Studies such as 2 suggest an escalating dosage concept, while others like 3 found that reducing the dose of epinephrine was not associated with a change in survival to hospital discharge or favorable neurological outcomes.
• Timing: Early administration of epinephrine is associated with a higher percentage of survival to discharge, as found in 4.
• Outcome: The use of epinephrine is associated with improved short-term survival, including return of spontaneous circulation (ROSC), but its effect on long-term survival and neurological outcomes is still unclear, as discussed in 5.

Key Findings

• The American Heart Association recommends the use of epinephrine in patients with cardiac arrest, as part of advanced cardiac life support 5.
• An escalating dosage concept may be beneficial, as it allows for titration of the drug to an effective level and meets the needs of the individual patient 2.
• Lower doses of epinephrine may be associated with more favorable neurological outcomes, as found in 4.
• The optimal dose and timing of epinephrine administration require further research to determine the most effective approach 3, 6.

Administration Guidelines

• The standard dose of epinephrine is 1 mg administered intravenously every 3-5 minutes, as recommended by the American Heart Association 6.
• Alternative dosage concepts, such as an escalating dose or a lower dose, may be considered, but more research is needed to determine their effectiveness 2, 3.