This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mark K. Reed Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Reed, M. K. Search for Related Content PubMed Articles by Reed, M. K. Related Collections Related Article

Avoidance of administration of 1 mg of adrenaline in cardiac arrest after cardiac surgery

Saint Barnabas/Newark Beth-Israel Cardiac Surgical ICU, Newark, New Jersey 07039, USA

Should adrenaline be routinely used by the resuscitation team if a patient suffers a cardiac arrest shortly after cardiac surgery?

Regarding the administration of (intravenous) epinephrine for the early-post-operative cardiac surgical patient after the fact of the occurrence of complete circulatory arrest [1] I am an agnostic.

That said, I have found i.v. bolus epinephrine can occasionally avert the aforementioned scenario for the patient in a rapid downward ‘death spiral’. In my experience this near-arrest physiology results from abrupt vasodilatory decompensation, for example when suddenly coughing (i.e. valsalva condition) as sedation wears off. And here is the point I would like to emphasize. The crucial form of epinephrine here is the 1 mg/10 cc (usually as a ‘Bristoject’ male leur lock adapter). Push and flush 50 to 100 mg (0.5 to 1 cc) and the patient in jeopardy pulls out of the dive just skimming the treetops. Push the ‘arrest dose’ of 1 mg/1 cc and as amply noted by others on this concept, the vasodilatory crisis morphs into a hemorrhagic disaster of busted suture line(s) or cannulation site(s).

In summary: Ban the 1 mg/1 cc epinephrine syringes. Keep the 1 mg/10 cc dosage form handy.

	Reference

Top Reference

 

1. Tsagkataki M, Levine A, Strang T, Dunning J. Should adrenaline be routinely used by the resuscitation team if a patient suffers a cardiac arrest shortly after cardiac surgery? Interact CardioVasc Thorac Surg 2008;7:457–463.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mark K. Reed Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Reed, M. K. Search for Related Content PubMed Articles by Reed, M. K. Related Collections Related Article