Evidence supporting the use of: Adrenaline
For the health condition: Cardiac Arrest

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Synopsis

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

Adrenaline (also known as epinephrine) is a cornerstone medication in the management of cardiac arrest, particularly in advanced cardiac life support (ACLS) protocols. Its use is strongly supported by both long-standing clinical practice and robust scientific evidence. Adrenaline acts primarily as a potent vasoconstrictor via alpha-adrenergic receptor stimulation, increasing aortic diastolic pressure and thereby improving coronary and cerebral perfusion during cardiopulmonary resuscitation (CPR). Multiple randomized controlled trials (RCTs) and systematic reviews, such as the PARAMEDIC2 trial published in the New England Journal of Medicine in 2018, have investigated its efficacy. These studies confirm that adrenaline increases the rate of return of spontaneous circulation (ROSC) and short-term survival. However, there is ongoing debate regarding its impact on long-term neurological outcomes, with some evidence suggesting only modest or no improvement in neurologically intact survival to hospital discharge. Guidelines from organizations such as the American Heart Association (AHA) and European Resuscitation Council continue to recommend adrenaline administration during cardiac arrest, particularly for non-shockable rhythms. In summary, the use of adrenaline in cardiac arrest is scientifically justified, with a solid evidence base supporting its physiological rationale and benefit for ROSC, though long-term outcome benefits remain an area of active research.

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