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Pharmacologic controversies in CPR

E R Gonzalez1

  • 1Medical College of Virginia, Richmond.

Annals of Emergency Medicine
|February 1, 1993
PubMed
Summary
This summary is machine-generated.

This review explores controversies in cardiopulmonary resuscitation (CPR) pharmacology, offering clinical practice recommendations for drug delivery and administration during cardiac arrest. Future research is needed to clarify optimal strategies.

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Area of Science:

  • Emergency Medicine
  • Pharmacology
  • Critical Care

Background:

  • Numerous controversies exist regarding cardiopulmonary resuscitation (CPR) pharmacology since the 1985 Emergency Cardiac Care Conference.
  • Key issues include drug pharmacokinetics/pharmacodynamics during CPR, optimal drug delivery vehicles, and specific dosages (e.g., atropine for brady-asystolic arrest).

Purpose of the Study:

  • To critically explore current controversies in CPR pharmacology.
  • To provide evidence-based recommendations for clinical practice.
  • To identify critical areas for future research in CPR drug management.

Main Methods:

  • Review of existing literature and clinical controversies in CPR drug administration.
  • Analysis of drug delivery routes, focusing on central vs. peripheral venous access.

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  • Evaluation of endotracheal drug administration as an alternative route.

    • Main Results:

    • Central circulation drug delivery is preferred during CPR due to hemodynamic changes.
    • Peripheral intravenous (IV) administration requires extremity elevation and IV fluid bolus.
    • Endotracheal administration is an option for epinephrine, lidocaine, and atropine if IV access is delayed, using a higher dose (2.5x IV) diluted in saline.

    Conclusions:

    • Dextrose 5% water is the primary vehicle, but glucose administration during CPR is controversial due to potential detrimental effects of hyperglycemia on neuronal function.
    • Current data are inconclusive on the impact of glucose levels on neurologic outcomes post-resuscitation.
    • Hyperglycemia may indicate prolonged resuscitation efforts and impaired insulin release.