Evidence supporting the use of: Adrenaline
For the health condition: Arrhythmia

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Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Adrenaline (also known as epinephrine) is scientifically validated for use in the management of certain life-threatening arrhythmias, particularly in the context of cardiac arrest. Clinical guidelines, such as those from the American Heart Association (AHA), recommend the administration of adrenaline during cardiopulmonary resuscitation (CPR) for patients experiencing pulseless ventricular tachycardia, ventricular fibrillation, pulseless electrical activity, or asystole. The primary rationale is that adrenaline acts as a potent vasoconstrictor via alpha-adrenergic receptors, which increases coronary and cerebral perfusion pressures during CPR. It also has beta-adrenergic effects contributing to increased heart rate and contractility, although these effects are less desirable in the arrest setting.

The use of adrenaline in this context is supported by numerous clinical studies and decades of practice. However, its efficacy in improving long-term survival and neurological outcomes is debated, with some recent studies suggesting that while adrenaline increases the rate of return of spontaneous circulation (ROSC), it has limited impact on favorable neurological survival. Nevertheless, its ability to restore circulation in acute settings is well established, justifying its inclusion in advanced cardiac life support (ACLS) protocols.

In contrast, adrenaline is not used to treat stable arrhythmias and may actually worsen certain arrhythmias due to its stimulatory effects on the heart. Its use is specifically reserved for life-threatening, shockable, or pulseless arrhythmias during resuscitation.

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