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RE: Epinephrine

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I am beginning to believe that epinephrine is probably harmful in cardiac

arrest. It may have a role in the 4-10 minute post arrest phase (circulatory

phase) but not before and not after. Failure of long-term survival from

cardiac arrest has been attributed to translocation of gram negative

bacterial flora (with their potent cardiotoxic endotoxins) from the gut to

the circulation following failure of the sodium/potassium pump in cells

protecting the organism from the gut flora. Epinephrine and vasopressin

causes significant interruption of blood flow to the gut thus facilitating

bacterial translocation and perhaps, in effect, sentence the patient to

death eventually despite immediate resuscitation.

If we are unable to show human benefit from epinephrine or vasopressin, why

use it?

BEB

E. Bledsoe, DO, FACEP

Midlothian, Texas

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