Drugs during cardiopulmonary resuscitation

Drug therapy continues to be recommended as part of cardiac arrest management. There has been increasing transparency about the lack of evidence to support such drug therapy, and the gaps identified in our knowledge have stimulated ongoing research. This review aims to highlight recently published articles that relate to the use of drugs during cardiopulmonary resuscitation (CPR).

Definitive studies have now been performed in human cardiac arrests, randomly comparing drugs with neutral controls. These publications have confirmed the short-term benefits of the standard drugs used in advanced life support (including epinephrine) when compared with no drugs. There are still many gaps in our knowledge, but a number of new approaches offer promise, including the use of intravenous lipid emulsions (in cardiac arrests due to local anesthetic toxicity), erythropoietin and even stem cells.

The use of some drugs (e.g. epinephrine) can be recommended in cardiac arrest, but only on the basis of short-term benefits. These short-term benefits need to be converted into long-term outcomes by optimizing management in the postarrest period. Potential drug strategies need to be evaluated in settings in which the drug is administered in a timely fashion, good CPR is provided, and postresuscitation care has been optimized.