[Pharmacology of cardiopulmonary resuscitation]

Among the adrenergic receptor agonists, epinephrine, at alpha and beta stimulating doses, remains the drug of choice for cardiopulmonary resuscitation. However, alpha adrenergic agonists such as phenylephrine, methoxamine and dopamine (at alpha stimulating doses) result in similar success rates of resuscitation as epinephrine. In the opposite, beta adrenergic agonists, without or with only low alpha stimulating effect, such as isoproterenol or dobutamine are significantly less efficient. There are few data indicating that sodium bicarbonate improves outcome. Moreover it carries the risk of adverse effects. It may be of benefit in case of preexisting metabolic acidosis or during prolonged resuscitation with documented acidosis. Calcium remains indicated in case of hypocalcaemia, hyperkalaemia or calcium channel blocker intoxication. Severe ionized hypocalcaemia can occur after out-of-hospital cardiac arrest.