title: Epinephrine for cardiac arrest.
abstract: OBJECTIVE
  Epinephrine is the primary drug administered during cardiopulmonary resuscitation (CPR) to reverse cardiac arrest. Epinephrine increases arterial blood pressure and coronary perfusion during CPR via alpha-1-adrenoceptor agonist effects. However, the dose, timing and indications for epinephrine use are based on limited animal data. Recent studies question whether epinephrine provides any overall benefit for patients.
  
  
  RESULTS
  A randomized controlled trial indicates that epinephrine for out-of-hospital cardiac arrest increases return of pulses, but does not significantly alter longer-term survival. Very large, well-controlled, observational studies suggest that, despite increases in return of pulses, epinephrine reduces long-term survival and functional recovery after CPR. Detrimental effects were greatest in patients found in ventricular fibrillation. Laboratory data suggest that harmful epinephrine-induced reductions in microvascular blood flow during and after CPR may offset the beneficial epinephrine-induced increase in arterial blood pressure during CPR.
  
  
  CONCLUSIONS
  The available clinical data confirm that epinephrine administration during CPR can increase short-term survival (return of pulses), but point towards either no benefit or even harm of this drug for more patient-centred outcomes (long-term survival or functional recovery). Prospective trials are needed to determine the correct dose, timing and patients for epinephrine in cardiac arrest.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA. callawaycw@upmc.edu
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
mesh_terms: D058646:Adrenergic alpha-1 Receptor Agonists / Q000008:administration & dosage / Q000009:adverse effects; D062186:Arterial Pressure / Q000187:drug effects*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002986:Clinical Trials as Topic; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D058687:Out-of-Hospital Cardiac Arrest / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function / Q000187:drug effects; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D058646:Adrenergic alpha-1 Receptor Agonists; D004837:Epinephrine