Vasopressors for cardiopulmonary resuscitation

Adrenaline (epinephrine) has been used for cardiopulmonary resuscitation since 1896; the rationale behind its use is thought to be its α-adrenoceptor-mediated peripheral vasoconstriction, causing residual blood-flow to be diverted to coronary and cerebral circulations. This protects these tissues from ischaemic damage and increases the likelihood of restoration of spontaneous circulation. Clinical trials have not demonstrated any benefit of adrenaline over placebo as an agent for resuscitation. Adrenaline has deleterious effects in the setting of resuscitation, predictable from its promiscuous pharmacological profile. This article discusses the relevant pharmacology of adrenaline in the context of cardiopulmonary resuscitation. Experimental and clinical evidence for the use of adrenaline and alternative vasopressor agents in resuscitation is given, and the properties of an ideal vasopressor are discussed.