Management of cardiac arrest caused by coronary artery spasm: epinephrine/adrenaline versus nitrates.
BACKGROUND
Cardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious.


RESULTS
A 49-year-old patient underwent an emergency coronarography with an attempt to stent the coronary arteries. Radiologic imaging revealed a positive methylergonovine maleate (Methergine, Novartis Pharmaceuticals, East Hanover, NJ) test, with subocclusive CAS in several coronary vessels leading to electromechanical dissociation. Cardiopulmonary resuscitation was performed, and intracoronary boluses of isosorbide dinitrate were given to treat CAS. Epinephrine/adrenaline was not administered during resuscitation. Spontaneous circulation was obtained after cardioversion for ventricular fibrillation, and the patient progressively regained consciousness.


CONCLUSIONS
Resuscitation guidelines do not specify the use of trinitrate derivatives in cardiac arrest situations caused by CAS. The pros and cons of the use of nitrates and epinephrine/adrenaline during cardiac arrest caused by CAS are analyzed in this case report.
Kiss
Gabor
G
Department of Anaesthesia and Surgical Intensive Care, University Hospital of Brest, France.
Corre
Olivier
O
Gueret
Gildas
G
Nguyen Ba
Vinh
V
Gilard
Martine
M
Boschat
Jaques
J
Arvieux
Charles Chistian
CC
D000322:Adrenergic Agonists / Q000627:therapeutic use*; D003329:Coronary Vasospasm / Q000150:complications* / Q000188:drug therapy; D004837:Epinephrine / Q000627:therapeutic use*; D006323:Heart Arrest / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D009566:Nitrates / Q000627:therapeutic use*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000322:Adrenergic Agonists; D009566:Nitrates; D014662:Vasoconstrictor Agents; D004837:Epinephrine