title: Management of cardiac arrest caused by coronary artery spasm: epinephrine/adrenaline versus nitrates.
abstract: 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.
authors.affiliation: Department of Anaesthesia and Surgical Intensive Care, University Hospital of Brest, France.
authors.forename: Gabor
authors.initials: G
authors.lastname: Kiss
authors.forename: Olivier
authors.initials: O
authors.lastname: Corre
authors.forename: Gildas
authors.initials: G
authors.lastname: Gueret
authors.forename: Vinh
authors.initials: V
authors.lastname: Nguyen Ba
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.forename: Jaques
authors.initials: J
authors.lastname: Boschat
authors.forename: Charles Chistian
authors.initials: CC
authors.lastname: Arvieux
mesh_terms: 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*
chemical_list: D000322:Adrenergic Agonists; D009566:Nitrates; D014662:Vasoconstrictor Agents; D004837:Epinephrine