I saw this question in the Lilac Garden Forum:
first Speaking of interval time and dosage, are you also using epinephrine combined with atropine to rescue patients with respiratory and cardiac arrest in clinical practice? But is it really reasonable to use it this way?
First learn about sudden cardiac arrest, also known as sudden cardiac death, which refers to any cardiac or non-cardiac patient, within an unestimated period of time, The sudden stop of the heartbeat is one of the most serious conditions of a cardiac emergency.
Sudden cardiac arrest: ①sudden loss of consciousness and convulsions;< /span>②Respiratory rate is slow and irregular, and then stops; urinary incontinence (indicating cardiac arrest has been 20 to 60 seconds); ③Aortic (carotid or femoral) pulsation disappeared and heart sounds disappeared; ④mydriasis (indicating cardiac arrest for 45 seconds) or immobilization (indicating cardiac arrest) Sudden arrest for 60 to 120 seconds), pale or cyanotic skin and mucous membranes, undetectable blood pressure [1].
Epinephrine combined with atropine is often used clinically to rescue patients with respiratory and cardiac arrest. Let’s discuss the changes in the status of the two drugs in cardiopulmonary resuscitation!
1Comparison of the pharmacological effects of epinephrine and atropine
2Atropine in rescue respiratory cardiac arrest Status
✦ Cardiopulmonary arrestThe most common cause of cardiorespiratory arrest is cardiac disease, which is commonly seen in Ventricular tachycardia and other tachyarrhythmias, sudden cardiac death from coronary heart disease, sudden cardiac death from cardiomyopathy, sudden cardiac death from heart failure, etc. The 2020 guideline recommends [2]: epinephrine should be given in any case for cardiopulmonary resuscitation, administered within 5 minutes of the start of chest compressions, and repeated every 3 to 5 minutes. until spontaneous circulation is restored. Atropine may lead to and/or aggravate ventricular quiescence due to hypertonia of the vagus nerve. As early as the 2010 AHA guidelines for cardiopulmonary resuscitation and the 2011 Chinese expert guidelines for cardiopulmonary resuscitation, it was mentioned that The routine use of atropine is not recommended< /span>. The following flowchart is from the 2018 AHA “International Consensus on Scientific and Treatment Recommendations for Cardiopulmonary Resuscitation and Emergency Cardiovascular Resuscitation”, Atropine is not mentioned, and its status can be seen to be deleted [3] .
The [2]Adult Basic and Advanced Life Support section of the guidelines recommends that CPR drugs are only epinephrine, amiodarone, or lidocaine ; Adrenaline, amiodarone, or lidocaine are also recommended in the flow chart for pediatric cardiac arrest in the basic and advanced life support sections of children; atropine is not mentioned in the adult basic and advanced life support principles of CPR. Atropine is only recommended in the presence of bradycardia and is recommended as [2]:
Summary
For no Pulse electrical activity/ventricular arrest, guidelines recommend CPR, epinephrine, amiodarone, or lidocaine, but atropine is not recommended, especially for respiratory and cardiac arrest due to hypoxia. In our clinic, atropine is often used to increase the heart rate, hoping to delay the occurrence of cardiac arrest, but the respiratory and cardiac arrest caused by hypoxia must first restore the oxygen supply. The use of atropine in palliative patients has potential risks. So is it possible that simply using epinephrine to increase the heart rate during ischemia and hypoxia may also increase the burden on the heart? Whether its beta-adrenergic effect is beneficial for resuscitation is controversial, as it increases myocardial oxygen consumption and reduces subendocardial blood supply. Looking forward to more research and consensus to answer us! Planning: MeichaoTitle image:Zhanku HailuoImage source: Guide text
References:[1] Ai Song Wenxuan, Li, Practical Cardiovascular Medicine /span>[2] “2020 AHA Guidelines for Cardiopulmonary Resuscitation and First Aid Cardiovascular”[3] “2018 AHA International Consensus on Scientific and Treatment Recommendations for Cardiopulmonary Resuscitation and Emergency Cardiovascular Resuscitation” [4] Liang Bin, Li Xihong, Interpretation of the 2020 update of the American Heart Association guidelines for children’s basic, advanced life support and neonatal resuscitation, West China Medicine, 2020, 11, 11(35): 1-7< span>[5] Qian Lulu et al., The effect of atropine on hypoxic bradycardia, accelerated cardiac arrest in rabbits, Chinese Journal of Medicine, 2012, 92(15): 1070-1073.