Comparison of adrenergic agonists for the treatment of ventricular fibrillation and pulseless electrical activity.

The primary role of epinephrine for the treatment of ventricular fibrillation (VF) and pulseless electrical activity (PEA) is to increase blood flow to the myocardium and central nervous system and ultimately improve survival. However, despite the administration of epinephrine, survival following VF or PEA is low. In an attempt to improve outcome from VF and PEA, alternative adrenergic agonists (methoxamine, phenylephrine, norepinephrine) which have different pharmacological properties than epinephrine have been evaluated. In order to determine the role of alternative adrenergic agonists for the treatment of VF and PEA this paper will compare the pharmacological properties and pharmacodynamic effects of these drugs to epinephrine. Specifically, receptor physiology along with the effects of adrenergic agonists on coronary perfusion pressure, survival, myocardial oxygen demand, and cerebral blood flow will be discussed.