Vasopressors for cardiopulmonary resuscitation. Does pharmacological evidence support clinical practice?
Adrenaline (epinephrine) has been used for cardiopulmonary resuscitation (CPR) since 1896. The rationale behind its use is thought to be its alpha-adrenoceptor-mediated peripheral vasoconstriction, causing residual blood flow to be diverted to coronary and cerebral circulations. This protects these tissues from ischaemic damage and increases the likelihood of restoration of spontaneous circulation. Clinical trials have not demonstrated any benefit of adrenaline over placebo as an agent for resuscitation. Adrenaline has deleterious effects in the setting of resuscitation, predictable from its promiscuous pharmacological profile. This article discusses the relevant pharmacology of adrenaline in the context of CPR. Experimental and clinical evidences for the use of adrenaline and alternative vasopressor agents in resuscitation are given, and the properties of an ideal vasopressor are discussed.
Penson
Peter E
PE
Division of Pharmacology, Welsh School of Pharmacy, Cardiff University, King Edward VII Avenue, Cathays Park, Cardiff, CF10 3NB, UK.
Ford
William R
WR
Broadley
Kenneth J
KJ
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004837:Epinephrine / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use; D006323:Heart Arrest / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D004837:Epinephrine