If you were having a heart attack, but now are experiencing cardiac arrest, is epinephrine good for you?
Here is what AHA (American Heart Association) states about ACS (Acute Coronary Syndrome – heart attacks and related conditions).
Sudden cardiac death may occur with any of these conditions. ACS is the most common proximate cause of sudden cardiac death.6–10
“Everybody dead gets Epi,” is what I tell students. It seems to help them remember the initial part of the arrest algorithms. Things have changed with the use of vasopressin as an alternative to epinephrine. Still, the thought process that goes into giving epinephrine is as mindless as ever.
If epinephrine is the wonder drug in cardiac arrest, and “ACS is the most common proximate cause of sudden cardiac death.6–10″ Then why is there not a single mention of epinephrine in the treatment of ACS. Go, search the document. Nothing.
Cardiac arrest is part of the expected progression of the ACS.
Cardiac arrest appears to be happening most often to those with ACS.
Epinephrine is the first IV drug given for all cardiac arrests.
Why is there no consideration of treating ACS with epinephrine, even accidentally?
Even if ACS is not the cause of cardiac arrest, but only coincidentally present, this is an important consideration.
How do these ACS patients benefit from epinephrine?
AHA does not even mention epinephrine, when discussing ACS treatment.
Is a vasopressor, such as epinephrine, essential for resuscitation?
Although epinephrine has been used universally in resuscitation, there is a paucity of evidence to show that it improves survival in humans. Both beneficial and toxic physiologic effects of epinephrine administration during CPR have been shown in animal and human studies.44–50
The placebo controlled trials of epinephrine in cardiac arrest have not shown any improvement in meaningful survival with epinephrine. So, epinephrine has not been shown to be better than a fake treatment.
Epinephrine is full of side effects. These are not considered to be good for ACS. It is not unreasonable to expect that most of the patients treated with epinephrine in cardiac arrest have ACS at the time of arrest.
Shouldn’t we be careful in giving epinephrine to these patients?
It may be that epinephrine does produce a long term benefit to some of these patients, but shouldn’t we find some way of discriminating among these patients to determine who might benefit?
Instead we indiscriminately give epinephrine to all patients in cardiac arrest.
The research does not support using epinephrine in cardiac arrest.
The physiology of giving epinephrine to someone with ACS is ignored.
(Circulation. 2005;112:IV-89 – IV-110.)
© 2005 American Heart Association, Inc.
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Part 7.2: Management of Cardiac Arrest
Part 8: Stabilization of the Patient With Acute Coronary Syndromes
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