Adrenaline Administration During Cardiac Arrest: Guidelines and Best Practices

Cardiac arrest is a life-threatening emergency that requires immediate intervention to increase the chances of survival. Every second counts, as brain cells can begin to die within six seconds of the heart stopping. Prompt action is essential to preserve neurological function and improve long-term outcomes.

Immediate Response: The Importance of CPR

The first step in managing cardiac arrest is to initiate high-quality cardiopulmonary resuscitation (CPR) as soon as possible. Chest compressions should be performed at a rate of 100–120 compressions per minute and a depth of 2–2.4 inches (5–6 cm). Starting CPR immediately helps maintain blood flow to vital organs, especially the brain, reducing the risk of irreversible damage.

Role of Adrenaline in Cardiac Resuscitation

While CPR is being performed, advanced life support measures should be initiated, including the administration of adrenaline (epinephrine). Adrenaline is a crucial medication in the treatment of cardiac arrest due to its ability to increase myocardial and cerebral perfusion pressure, which enhances the likelihood of return of spontaneous circulation (ROSC).

Initial Dosing of Adrenaline

The recommended initial dose of adrenaline is 1 mg administered intravenously (IV) or intraosseously (IO). This dose can be repeated every 3–5 minutes if there is no response. There is no maximum limit for adrenaline administration, although clinical judgment should guide repeated dosing based on the patient's condition and response to treatment.

Alternative Dosing and Considerations

In some cases, a higher initial dose of adrenaline, such as 2 mg IV, may be considered, particularly in prolonged or refractory cardiac arrest. However, this approach should be used cautiously and only in specific clinical scenarios under the guidance of advanced cardiac life support (ACLS) protocols.

Adjunctive Treatments and Supportive Care

In addition to adrenaline, other medications and interventions play a vital role in the resuscitation process. For example, norepinephrine can be administered via intravenous infusion or bolus to support blood pressure and improve perfusion. If metabolic acidosis is present, sodium bicarbonate may be given intravenously to correct acid-base imbalances.

Airway Management and Oxygenation

Securing the airway is another critical component of cardiac arrest management. Oxygen delivery should be optimized through bag-mask ventilation or advanced airway techniques. Early endotracheal intubation followed by mechanical ventilation is recommended to ensure adequate oxygenation and reduce the risk of hypoxia during resuscitation efforts.

Conclusion: A Comprehensive Approach to Cardiac Arrest

Effective management of cardiac arrest involves a coordinated, multi-faceted approach that includes prompt CPR, appropriate medication administration, and advanced airway support. Adrenaline remains a cornerstone of pharmacological therapy, and understanding the correct dosing and timing is essential for healthcare providers. By following established guidelines and adapting interventions based on patient response, medical professionals can significantly improve survival rates and neurological outcomes in cardiac arrest patients.