Epi infusion during cardiac arrest

[mobey]

Wondering if anyone uses Epi infusions during codes? We were discussing it in school today and I thought it would be interesting to find out.

Mobey

[akroeze]

My preceptor suggested possibly running Dopamine at full dose in addition to the Epi during an arrest.... didn't discuss it further unfortunately.

[Arizonaffcep]

Wondering if anyone uses Epi infusions during codes? We were discussing it in school today and I thought it would be interesting to find out.

Mobey

No. But if we get a pulse & pressure back, Levophed (nor-epi) is usually used in combo with Dopamine. From my understanding, Levo has at least as good inotropic effects with lessened chronotropic effects when compared to Dopamine.

[mobey]

Hmmm... not sure about Dopamine (gotta think on this)

We were discussing loading the Pt with 1mg, then set up an infusion and continue atropine/Amiodarone respectivly. Then after 15 min or so set up a bicarb drip.

[Arizonaffcep]

Hmmm... not sure about Dopamine (gotta think on this)

We were discussing loading the Pt with 1mg, then set up an infusion and continue atropine/Amiodarone respectivly. Then after 15 min or so set up a bicarb drip.

What rhythm were you discussing with this?

[mobey]

What rhythm were you discussing with this?

Any...... (Atropine/Amio used in thier appropriate places)

[Arizonaffcep]

Interesting. From what you've posted, I would assume that you are still ACTIVELY coding this person? My only thought on it vs not doing it is, what is the 1/2 life of the medicine? Would it be worth setting up an infusion if a therapeutic level can be maintained with 1mg every 3-5 minutes? What would the gain be? Also, after about 3mg of Atropine, you have maxed out its effectiveness.

[chbare]

Well, dopamine is not exactly a medication we use for the patient in arrest regardless of rhythm. In addition, no solid evidence pointing to better outcomes with epinephrine use in arrest exists. Why go through all the trouble of setting up an epinephrine infusion when it's use really does not seem to effect outcomes in the first place?

Take care,

chbare.

[mobey]

Basically we are discussing administering the infusion to take one step out of the equasion. It is just as easy to put 1mg into a 500ml bag giving you a 2mcg/ml concentration and having a constant infusion rather than incremental dosing. There is no literature to support this as far as I know, it was just a discussion we were having. The only answer to "why?" I can give is convienience, as there is no study on continuous infusion vs incremental dosing. If you were a lone medic, once the atropine is in you are free to do whatever else may need done because you are not pushing a drug every 5 min.

Yes I am very aware this is all anecdotal!

I am just a student with lots of questions LOL.

[Ridryder 911]

High dose Epi has not been proven to be any further beneficial in cardiac arrest as many assumed or still try to persuade.

Dopamine is not indicated in cardiac arrest as it increases myocardial oxygen consumption.

I have seen Cardiologist perform pharmacological shock. Using a a Beta such as Isuprel wide open then immediately using a pure Alpha such as Levophed. Usually if there is no response the arrest is terminated.

R/r 911