Adrenaline Resuscitation: Future Treatment of Cardiac and Peri-arrest
Adrenaline Resuscitation: Future Treatment of Cardiac and Peri-arrest
The use of adrenaline to resuscitate patients suffering from cardiac arrest has a long history having originated from experimental studies conducted in the 1960s. For a long time, adrenaline has been one of the most widely used medical interventions having been approved by the AHA (America Health Association). The use of adrenaline has however been a contentious issue in recent times as different scholars evaluate the actual effectiveness of the cardiac arrest intervention. In this analysis, we are going to conduct a literature review on various sources determining their view on the use of adrenaline.
The use of adrenaline to support cardiac arrest patients has been used for a long time showing favorable results. According to Hawkes, (2018) research conducted on patients who suffered from heart attacks in hospitals found out that epinephrine increased the likelihood of return of spontaneous circulation (ROSC). The study also conducted a comparison of those patients who received epinephrine intervention and those who did not and discovered that epinephrine through more effective, it also reduced the chances of 30-day survival (Jung et al., 2018).
Most researchers acknowledge the effectiveness of peripherin in the ROSC. However, in recent times, the use of epinephrine has been contentious as observers discover that despite the technique restarting the heart, it also reduces the chances of survival and also increases the chances of brain damage. In a study, the American College of Cardiology (2014), acknowledged that the issue of epinephrine is more than questionable. Based on the lead author Ph.D. Florence Dumas epinephrine is effective in ROSC, however, she acknowledges that despite the drug being effective in resuscitation, it also decreases the chances of survival in the post-resuscitation period and with the brain functioning normally.
The American College of Cardiology, (2014) conducted an empirical study on 1500 patients admitted to a Parisian hospital over 12 years. Based on the findings, patients who received epinephrine had more adverse post-resuscitation effects with those receiving 1 mg of the dosage exhibiting a 52% chance of having negative effects whereas those receiving 5 mg or more displaying a 77% chance of displaying negative effects. According to the American College of Cardiology (2014), the timing of epinephrine was seen as a major factor influencing survival. Patients who received epinephrine at the later stages had a higher likelihood of dying as compared to those who received the intervention at the right time.
According to the head author Dumas of the American College of Cardiology, there is no need for an immediate drop of epinephrine as an intervention method since it displays favorable results in lower doses if administered in the first few minutes after a heart attack (Angelos et al., 2007). However, Dumas advocates for additional research to be conducted to determine other safer interventions that may prove effective and also reduce the post-resuscitation effects. The study concludes that it would be dangerous to completely incriminate against the drug; however, it is crucial to continue research to come up with safer drug and drug combination alternatives to epinephrine.
In my opinion, I believe that the American College of Cardiology exhaustively solved the contentious issue about the administration of epinephrine. I agree with Dumas that despite epinephrine showing unfavorable outcomes in human trials, it is still not right to eliminate it since it still offers a significant recovery rate as compared to failure to use any drug at all. I also agree with the research that epinephrine should be included in future drugs or even combinations to increase efficiency.
This research has however failed to deal with contemporary issues on the timing of intervention in determining the efficacy of adrenaline in dealing with cardiac arrest.
In a study conducted by Perkins et al., (2018), around 30,000 individuals suffer from heart attacks in the US with only 10% of this population surviving. According to the study, the chances of survival are dependent upon early detection and intervention. According to Perkins et al., the best interventions are CPR (Cardio-Pulmonary Resuscitation) and defibrillation. The study also goes ahead to depict the administration of adrenaline as a last result intervention. Adrenaline is the drug name of epinephrine. Epinephrine drug functions through increasing blood flow to the heart; in such instances, blood flow in small blood vessels is reduced which could potentially lead to brain damage.
Observational studies have shown that over 500,000 patients treated with epinephrine suffered adverse post-resuscitation effects with most of these cases being brain damage (Perkins et al., 2018). Over the years, there has been no definitive study conducted to determine the effectiveness of adrenaline in supporting cardiac arrest patients. Due to recent findings on the harmful post-resuscitation effects, the International Liaison Committee on Resuscitation conducted a PARAMEDIC 2 trial supported by animal studies to assess whether adrenaline was harmful or beneficial in generally dealing with heart attacks resuscitation (Perkins et al., 2018).
Based on the PARAMEDIC 2 trial conducted by Perkins et al., 3.2% of the patient’s given adrenaline were alive as compared to 2.4% of the patients given placebo in the first 30 days of post-resuscitation (Perkins et al., 2018). In addition, 30.1% of the patient’s given adrenaline had severe brain damage as compared to 18.1% of those given placebo (Perkins et al., 2018).
Based on this experimental study, it is evident that many individuals survived having been given adrenaline. However, a significant number of survivors had severe brain damage having been given adrenaline. The physiological explanation of the PARAMEDIC 2 trial postulates that despite adrenaline increasing macrovascular cerebral perfusion pressures, adrenaline may also lead to microvascular ischemia thereby leading to anoxic brain damage. The lead author professor Gavin Perkins concludes that there are small benefits of the administration of adrenaline with 1 out of 125 patients surviving (Perkins et al., 2018). In addition, he concludes that there is a great risk of administration of adrenaline as it predisposes individuals to severe brain damage. Speaking in a science media center in London, professor Perkins was reluctant to commit himself on whether to ban adrenaline as a means of resuscitation citing that such a decision would require further considerations (Hawkes, 2018).
I believe this study to be one of the greatest research studies that painted a real picture of the actual efficacy of epinephrine drugs administration. I concur with the findings that epinephrine has very limited efficiency as only 1 in 125 patients recover having been given adrenaline in the resuscitation process. In my opinion, I believe the research comprehensively covered the recent contentious issue about its use in the resuscitation process. The research also depicts the dire need for more research to be conducted to establish more effective resuscitation techniques.
The research however fails to cover the timing aspect of adrenaline administration. In addition, the research also fails to cover the various types of shocks in patients to determine the actual efficiency of adrenaline.
A study conducted by Attaran & Ewey, (2010) depicts that epinephrine (Adrenaline) could either act as a cure or curse based on various factors. These factors include; timing of application, dosage, and patient’s conditions. The empirical study conducted shows that there is a high correlation between the amount of dosage and actual mortality rates from patients resuscitated using adrenaline. According to Attaran and Ewy, administration of adrenaline at high levels increases the actual likelihood of mortality and resultant brain damage in the case the patients survive. The study also discovered a significant relationship between the timing of administration and the mortality rates. According to the study, administration of vasopressor drugs early is crucial for achieving adequate perfusion pressures to vital organs and thereby increasing chances of successful deflation. Attaran and Eyew argue that epinephrine can either be a cure or curse and therefore advocates for strict care to be taken in ensuring it is administered at low dosages and early enough to maximize its effectiveness in resuscitating patients having a cardiac arrest.
Based on the research conducted by Attaran and Eyew (2010); I agree with the researchers that the efficiency of epinephrine is heavily dependent on the timing of administration and the dosage used. I also concur with the idea that the continued recommendation of epinephrine by health practitioners in the case of cardiac arrest has emanated from a lack of a more suitable alternative alongside animal trials that have exhibited positive outcomes.
The research conducted by Attaran and Eyew 2010 has various limitations. First, the study fails to offer a definitive solution to the epinephrine drug administration to patients suffering from cardiac arrest. Secondly, the research is observational basing its argument on animal trials; it can therefore not be relied upon to objectively determine whether adrenaline should be included as a treatment in dealing with cardiac arrests and peri arrests.
In conclusion, epinephrine continually been used over the years based on decades of efficacy as depicted in animal trials. Epinephrine has however performed very poorly in human trials as depicted in recent studies and especially in the PARAMEDIC 2 trial. Epinephrine administration has for a long time depended on observational studies and subsequently advocates for early administration as in the case of Attran and Eyew (2010). One of the most notable features of these studies and trials is the fact that epinephrine could be an actual cause of death in the cases it is administered in higher dosages or very late thus proving ineffective to patients. Epinephrine has continually depicted low levels of efficacy as shown by most recent studies. Despite the crucial findings on the poor efficacy of adrenaline, there has been almost no defensive research aimed to defend epinephrine’s efficiency. Researchers are continually conducting trials and research on epinephrine and also trying to come up with alternatives that could substitute adrenaline in dealing with shock. In the future, it will be crucial to relax the policies surrounding it.
American College of Cardiology. (2014, December 1). For cardiac arrest, epinephrine may do more harm than good. ScienceDaily. Retrieved July 1, 2021, from www.sciencedaily.com/releases/2014/12/141201163227.htm
Attaran, R. R., & Ewy, G. A. (2010). Epinephrine in resuscitation: Curse or cure? Future Cardiology, 6(4), 473-482. https://doi.org/10.2217/fca.10.24
Hawkes, N. (2018). Adrenaline after cardiac arrest doubles the risk of serious brain damage finds trial. BMJ, k3145. https://doi.org/10.1136/bmj.k3145
Jung, J., Rice, J., & Bord, S. (2018). Rethinking the role of epinephrine in cardiac arrest: The PARAMEDIC2 trial. Annals of Translational Medicine, 6(S2), S129-S129. https://doi.org/10.21037/atm.2018.12.31
The University of Warwick. (2018, July 20). Using adrenaline in cardiac arrests results in less than one percent more people leaving the hospital alive: But nearly doubles the survivors’ risk of severe brain damage. ScienceDaily. Retrieved July 1, 2021, from www.sciencedaily.com/releases/2018/07/180720154915.htm