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

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Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Norepinephrine is a potent vasopressor used in critical care settings for the management of shock states, particularly septic shock, due to its strong alpha-adrenergic agonist effects that increase vascular tone and blood pressure. However, its use in cardiac arrest is not the standard of care and is not broadly supported by high-quality evidence. The current international guidelines for cardiac arrest primarily recommend the use of epinephrine as the first-line vasopressor during cardiopulmonary resuscitation (CPR). Norepinephrine may be considered in specific cases where hypotension persists after return of spontaneous circulation (ROSC), but not as a primary agent during active cardiac arrest. A few observational studies and some animal models have investigated norepinephrine's effects during cardiac arrest, but there is limited clinical trial evidence demonstrating improved outcomes compared to epinephrine. Norepinephrine's primary role remains in post-resuscitation care to manage refractory hypotension rather than as a resuscitative medication. Thus, while there is some scientific rationale for its use—based on its vasoconstrictive properties—the evidence base is weak, and its use during actual cardiac arrest is not widely practiced or recommended by major resuscitation councils.

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