Epinephrine in Cardiac Arrest: Is It Enough?

Introduction: Epinephrine has long been the clinical mainstay of pharmacologic treatment for cardiac arrest management. It provides both α- and β-adrenergic receptor activation. However, at higher dosages, it may lead to sympathetic overload, oxidative stress, and cardiac myocyte apoptosis. The purpose of this paper is to evaluate the rates of ROSC (return of spontaneous circulation) with in-hospital cardiac arrest between epinephrine monotherapy and VSE (vasopressin, steroid, and epinephrine). Methods: A search via PubMed database using the keywords “Cardiac arrest” AND “VSE” AND “Vasopressor monotherapy” with additional specifiers resulted in 30 articles. 26 articles were removed due to study type and characteristics. What remained were four studies consisting of a randomized controlled trial and three meta-analyses. Results: In four articles reviewed, there was an overall increase in rates of ROSC in patients receiving VSE compared to those receiving epinephrine monotherapy as a placebo (P < 0.034). One study demonstrated that vasopressin and epinephrine together did not increase rates of ROSC. But with the addition of glucocorticoids ROSC improved. Patients in all studies received baseline cardiopulmonary resuscitation in accordance with current guidelines. Conclusion: VSE therapy in limited studies has been proven efficacious for improving rates of ROSC in adult patients suffering from cardiac arrest when compared to sole administration of epinephrine as the vasopressor of choice. However, this treatment modality will need to obtain a larger sample size before results can be validated.