DescriptionSympathetic agonist, neurotransmitter and catecholamine

Cardiac, Vascular,

Respiratory & Systemic

Indications

Cardiac arrest, bradycardia and cardiogenic shock

Anaphylaxis, severe allergic reaction and refractory airway disease

Croup (an alternative preparation is racemic adrenaline)

Mechanism of ActionActivation of alpha-1 adrenoreceptors induces vasoconstriction leading to increases in systemic vascular resistance, blood pressure, cerebral and coronary blood flow. Activation of beta-1 adrenoreceptors induces increased heart rate and cardiac contractility leading to increase cardiac output.  Activation of beta-2 adrenoreceptors induces bronchodilation.
Pharmacokinetics

Onset

< 2 minutes

Peak Effects

2-5 minutes

Duration

5-10 minutes

ContraindicationsNone in its listed indications
Adverse EffectsHeart palpitations, anxiety, tremors, headache, dizziness, nausea, vomiting, tachycardia, arrhythmias and increased myocardial oxygen demand
Precautions & Facts

Can be deactivated by alkaline solutions and IV doses should be reserved for cardiac arrest or refractory cases of respiratory distress, bradycardia or shock.

Caution required in pregnancy, tachycardias or geriatric patients.

Preparation1 mg/mL ampoules and 0.15, 0.3 or 0.5 mg auto-injectors (1:1,000) or 1 mg/10 mL mini-jets and 1 mg/10 mL ampoules (1:10,000)
Research:

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Aronson, J. (2000). Where name and image meet”—the argument for “adrenaline. BMJ, 320(February), 1998–2001. Retrieved from http://www.bmj.com/content/320/7233/506.1?variant=full-text

Arrich, J., Sterz, F., Herkner, H., Testori, C., & Behringer, W. (2012). Total epinephrine dose during asystole and pulseless electrical activity cardiac arrests is associated with unfavourable functional outcome and increased in-hospital mortality. Resuscitation, 83(3), 333–337. https://doi.org/10.1016/j.resuscitation.2011.10.027

Attaran, R. R., & Ewy, G. a. (2010). Epinephrine in resuscitation: curse or cure? Future Cardiology, 6(4), 473–482. https://doi.org/10.2217/fca.10.24

Bennett, M. (2000). The concept of transmitter receptors: 100 years on. Neuropharmacology, 39(2000), 523–546. Retrieved from http://www.sciencedirect.com/science/article/pii/S0028390899001379

Bennett, M. (1999). One hundred years of adrenaline: the discovery of autoreceptors. Clinical Autonomic Research. Retrieved from http://link.springer.com/article/10.1007/BF02281628

Biondi-Zoccai, G. G. L., Abbate, A., Parisi, Q., Agostoni, P., Burzotta, F., Sandroni, C., … Biasucci, L. M. (2003). Is vasopressin superior to adrenaline or placebo in the management of cardiac arrest? A meta-analysis. Resuscitation, 59(2), 221–224. https://doi.org/10.1016/S0300-9572(03)00234-X

Böttiger, B. W., Teschendorf, P., Bernhard, M., & Nolan, J. (2010). Adrenaline–more questions than answers. Resuscitation, 81(6), 637–638. https://doi.org/10.1016/j.resuscitation.2010.03.024

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Burnett, A. M., Segal, N., Salzman, J. G., McKnite, M. S., & Frascone, R. J. (2012). Potential negative effects of epinephrine on carotid blood flow and ETCO2 during active compression-decompression CPR utilizing an impedance threshold device. Resuscitation, 83(8), 1021–1024. https://doi.org/10.1016/j.resuscitation.2012.03.018

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Jeung, K. W., Ryu, H. H., Song, K. H., Lee, B. K., Lee, H. Y., Heo, T., & Min, Y. Il. (2011). Variable effects of high-dose adrenaline relative to standard-dose adrenaline on resuscitation outcomes according to cardiac arrest duration. Resuscitation, 82(7), 932–936. https://doi.org/10.1016/j.resuscitation.2011.03.007

Koscik, C., Pinawin, a, McGovern, H., Allen, D., Media, D. E., Ferguson, T., … Swor, R. (2013). Rapid epinephrine administration improves early outcomes in out-of-hospital cardiac arrest. Resuscitation, 84(7), 915–920. https://doi.org/10.1016/j.resuscitation.2013.03.023

Kudenchuk, P. J. (2013). Early epinephrine in out-of-hospital cardiac arrest: is sooner better than none at all? Resuscitation, 84(7), 861–862. https://doi.org/10.1016/j.resuscitation.2013.05.003

Kunihiko, M., Tanno, K., Hase, M., & Mori, K. (2012). Cumulative dose of adrenaline and neurological outcome among out-of-hospital cardiac arrest patients resuscitated with extracorporeal membrane oxygenation. Resuscitation, 83, e16. Retrieved from http://dx.doi.org/10.1016/j.resuscitation.2012.08.042

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Letter to the Editor. (2012), 83(September 2011), 9572. https://doi.org/10.1016/j.resuscitation.2011.09.035

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