Epinephrine question

[patzyboi]

So people say that epinephrine doesn't improve chances of survival during a cardiac arrest, so why do paramedics still continue to use it during a cardiac arrest?

Also, most cardiac arrest rhythms are an arrhythmic rhythm so there's electricity in the heart, just not beating efficiently, why do paramedics give this drug when the heart is already beating (chaotically)

 

[RedAirplane]

Maybe try the ALS forum where the paramedics live.

 

[Martyn]

"Epinephrine produces beneficial effects in patients during cardiac arrest, primarily because of its α-adrenergic (ie, vasoconstrictor) effects. These α-adrenergic effects of epinephrine can increase coronary perfusion pressure and cerebral perfusion pressure during CPR. The value and safety of the β-adrenergic effects of epinephrine are controversial because they may increase myocardial work and reduce subendocardial perfusion. The 2010 Guidelines stated that it is reasonable to consider administering a 1-mg dose of IV/IO epinephrine every 3 to 5 minutes during adult cardiac arrest."

Quoted from the 2015 AHA ECC guidelines

 

[Martyn]

https://eccguidelines.heart.org/index.php/american-heart-association/

More info can be found here

 

[Underoath87]

Why do we use it? Because we used to believe that it worked for resuscitation, so we'll keep using it until proven certain that it is hindering resuscitation.

 

[EpiEMS]

Why do we use it? Because we used to believe that it worked for resuscitation, so we'll keep using it until proven certain that it is hindering resuscitation.

Lack-of-evidence-based-practice: e.g. Backboards

 

[RedAirplane]

My vague understanding (based on listening to "Inside EMS") is that per the 2015 AHA guidelines, epinephrine is due for more study, but has marginal evidence suggesting it is helpful in the right patients if given correctly.

 

[Akulahawk]

If you look at the EmCrit website, one of the podcasts http://emcrit.org/podcasts/hemodynamic-directed-dosing-epinephrine/ there covered the idea of giving epi to patients only under certain conditions. Very interesting discussion about individualizing epi dosing to each patient.

 

[k9Dog]

We give it to constrict the vessels which increase the pressure in the coronary arteries which perfuse the heart itself. The heart/brain tissues begin to die to in minutes, and chance of survival exponentially decreases with each minute. I haven't read the studies but I believe there's evidence of Epi vs nothing being more effective or the AHA would have tossed it out like atropine

 

[Bullets]

Tradition

 

[patzyboi]

the reason people i know use it is because its always been done that way

 

[reaper]

New guidelines call for epi asap in PEA. Falls further down the line in all other rhythms. Largest studies show increase in ROSC rates with epi use, but may have decrease in neurological outcomes. The way they look at it right now is you have no outcomes without ROSC.

 

[teedubbyaw]

Why? Because it's protocol. There are certain things, such as cardiac arrest, where you can't just say I don't want to give epi because I don't believe in it.

 

[MS Medic]

Why? Because it's protocol. There are certain things, such as cardiac arrest, where you can't just say I don't want to give epi because I don't believe in it.

And at the end of the day, regardless of any theoretical discussions, if you deviate from your protocols without online medical direction, your practicing without a license.

 

[k9Dog]

You should know WHY it's protocol, why it works and how it works... Or else you're just a cookbook medic

 

[TransportJockey]

And at the end of the day, regardless of any theoretical discussions, if you deviate from your protocols without online medical direction, your practicing without a license.

Or you have guidelines instead that cover you for beinh able to critically think and a medical director that knows that not everythinh fits neatly into a protocol

 

[hogwiley]

I guess mainly because THEORETICALLY(and likely in practice when given properly in conjunction with high quality CPR) it should result an increase in the likelihood of ROSC. Its used more for its vasoconstrictive effects than beta effects, which is why Vasopressin can also be used initially instead..

 

[COmedic17]

Studies show it doesn't increase hospital-to-discharge survival rate, but it does increase the likely hood of ROSC.

Im some cases, it's beneficial. In others, not so much.