ADRENALINE - FRIEND OR FOE?

Abstract

Adrenaline has been ubiquitously recommended as a drug of choice in sudden cardiac death in the setting of asystolic, pulseless or fine ventricular fibrillation rhythm. In spite of being in vogue for more than half a century, there are only a few properly conducted randomized clinical studies to support its use. Its potent positive chronotropic and inotropic effect may behave like a double edge sword causing severe vasoconstriction resulting in ischeamia on one hand and proarrhythmia leading to further serious arrhythmias on the other hand. This raises some doubts about the efficacy and deleterious effects of adrenaline in the scenario of sudden death. Based on the current evidence, use of Adrenaline can still be recommended but considering the potential side effects the dose should be limited to just 1 mg. It may be prudent to consider switching to other medicines that have already been approved in the guidelines. In the scenario of pulseless VT or VF, the most important step is to institute early CPR and perform defibrillation/shock as soon as possible.