The use of epinephrine in cardiac resuscitation and its role in anoxic brain damage
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Cardiac arrest is a lethal condition that can arise from numerous underlying etiologies. Cardiopulmonary resuscitation (CPR) is the centerpiece of its treatment for healthcare professionals and lay people alike. Several medications have been investigated as a potential treatment for cardiac arrests over the years but only epinephrine has been used as a mainstay treatment for all causes of cardiac arrest. However, this treatment was adopted as the gold standard prior to any thorough assessment of its efficacy or safety. In recent years there have been growing concerns in the scientific community that epinephrine may further propagate anoxic brain damage and may not be as efficacious as originally believed. Epinephrine is proposed to increase blood pressure and heart rate, which may increase the probability of achieving return of spontaneous circulation (ROSC). However, this may come at the cost of an increased risk of stroke and oxygen demand, thereby causing additional anoxic brain damage. While there have been a few studies that investigated the efficacy of epinephrine, few have explored the impact it may have on a patient’s neurological status following a cardiac arrest. None of the studies focused on the neurological outcome of cardiac arrest patients due to the use of epinephrine had the proper sample size or power to properly assess epinephrine’s role. Additionally, in these studies the neurological outcome was not the primary endpoint and, as such, there was limited data collected to analyze neurological status. The proposed double-blind randomized controlled trial will compare epinephrine and placebo by assessing the neurological status of cardiac arrest patients prior to hospital discharge. By including imaging and standardized testing this study hopes to build upon those studies that first raised the question of epinephrine’s safety. With this thorough investigation of epinephrine’s role in anoxic brain damage during cardiac arrest, a greater understanding of epinephrine’s risks and benefits can be developed. This will allow for epinephrine’s role in cardiac arrest to be properly reexamined and to effectively establish its appropriate role.