Adrenaline in cardiac resuscitation

• alpha-adrenergic actions of adrenaline cause vasoconstriction, which increases myocardial and cerebral perfusion pressure during cardiac arrest
• adrenaline is given immediately after confirmation of the rhythm and just before shock delivery (drug–shock–CPR–rhythm check sequence)
  • have adrenaline ready to give so that the delay between stopping chest compression and delivery of the shock is minimised
  • adrenaline that is given immediately before the shock will be circulated by the CPR that follows the shock
  • when the rhythm is checked 2 min after giving a shock, if a non-shockable rhythm is present and the rhythm is organised (complexes appear regular or narrow), try to palpate a pulse
    • rhythm checks must be brief, and pulse checks undertaken only if an organised rhythm is observed
    • if an organised rhythm is seen during a 2 minute period of CPR, do not interrupt chest compressions to palpate a pulse unless the patient shows signs of life suggesting return of spontaneous circulation (ROSC)
    • if there is any doubt about the existence of a pulse in the presence of an organised rhythm, resume CPR
    • if the patient has ROSC, begin post-resuscitation care
  • if the patient’s rhythm changes to asystole or pulseless electrical activity (non-shockable rhythms), give adrenaline 1 mg IV immediately intravenous access is achieved
  • in both VF/VT and PEA / asystole, give adrenaline 1 mg IV every 3-5 min (approximately every other two-minute loop). In patients with a spontaneous circulation, doses considerably smaller than 1 mg IV may be required to maintain an adequate blood pressure

Reference:

1. Resuscitation Council (UK). Adult Advanced Life Support. Resuscitation Guidelines 2005.