The Correct Way to use Adrenaline in Resuscitation
WHAT DOES ADRENALINE DO?
Adrenaline is always the first drug given during cardiac arrest and hence it is readily available in all clinical institutions. The reason for this is that adrenaline concentrates the blood around the vital organs, especially the brain and the heart, by the process of peripheral vasoconstriction. These organs need constant blood supply to increase the chance of surviving after a cardiac arrest.
Adrenaline also improves the cardiac contractions by stimulating the cardiac muscles. This increases the amount of blood which circulates to the vital organs, thus elevating the chances of the heart returning to its original rhythm.
But before administering adrenaline, one must be as well-versed with the process as one is regarding the Ambu bag price in India.
USAGE OF ADRENALINE
The usage of adrenaline in the treatment of cardiac arrest or a resultant resuscitation has been prevalent for many years. The reason behind this is that adrenaline increases the possibility of the phenomenon of return of spontaneous circulation (ROSC).
The addition of adrenaline in the resuscitation guidelines across the world is because of its action of increasing coronary and cerebral perfusion pressure, which increases the probability of restoring a heartbeat. It also improves long-term neurological outcome. But the previous point is often contested. Some believe that in fact, the adrenaline usage leads to a reduced neurological outcome. Hence, it is very important to use adrenaline correctly during resuscitation.
Adrenaline can be provided to the patient repeatedly during a cardiac arrest and this should be continued till the condition of the patient improves. The Resuscitation Council strongly recommends that adrenaline is provided as soon as the cardiac arrest and its nature has been decided and distinguished. Once administered, it can be repeated every three to five minutes for the best result.
- The administration route is through a central line, as it can reach the cardiac tissue in less time. If a central line is not available, a cannula in a peripheral vein is a good idea. In the case of the latter, the cannula should be flushed with minimum of 20ml of 0.9 per cent sodium chloride.
- If a venous access is not obtained and the patient is under intubation, adrenaline can be administered through the endotracheal tube directly into the lungs. It can also be injected directly into the heart; however, it is a difficult procedure and must be only attempted by a competent medical professional, and only after all other attempts to gain access have failed.
- After establishing a rhythm, the use of adrenaline can be analyzed as too much can precipitate ventricular fibrillation. One important thing to note is that adrenaline reacts negatively with sodium bicarbonate to result in solid material. Hence, these two drugs should never be supplied via the same IV route without 0.9 per cent sodium chloride flushing.
THE RIGHT DOSAGE
More than the type of sutures in a surgery, it is important to understand that the drug dosage. The adrenaline dosage depends on the state of the patient. For example, giving 1 mg of adrenaline to a heart that has just restarted can have troubling consequences. This increased afterload can lead to a loss of circulation. The aim should be to achieve a coronary perfusion pressure between 15 – 20 mmHg. The best way to decide the right dosage is constant and accurate monitoring of the patient. This requires an ultrasound and the patience of the caregivers.
WHEN SHOULD ADRENALINE NOT BE ADMINISTERED?
There are various instances when adrenaline should not be given to the patient:
- If the heart is still beating and the diastolic blood pressure is below 40 mmHg. If the blood pressure is anything less than this, a little quantity of adrenaline, perhaps 30 to 50 mcg can be given.
- In the case of a refractory VT/VF. This happens because of a catecholamine surge. Adrenaline, therefore, will only increase the surge further. If it is not possible to get the patient out of these rhythms, it is a good idea to stop the supply of adrenaline.
- Giving adrenaline very late in the resuscitation is not a good idea. There is a time in which the patient must be given adrenaline to experience a successful resuscitation. For instance, the electrical phase, which occurs in the first few minutes after the cardiac arrest, does not benefit from adrenaline. The circulatory phase, which lasts for 10 to 15 mins is the time when the patient benefits the most from adrenaline. However, the metabolic phase, which occurs after 20 minutes of the cardiac arrest, can become worse if adrenaline is given.