Kuiper Michael A
Medisch Centrum Leeuwarden, afd. Intensive Care.
Contact: M.A. Kuiper (
Ned Tijdschr Geneeskd. 2018 Dec 17;162:D3519.
Although epinephrine has been a cornerstone in resuscitation medicine for over 60 years, its use had never been thoroughly studied until recently, probably because the benefits of epinephrine seemed so obvious. The vasoconstriction of arterioles mediated by α-adrenergic receptors, leading to a higher coronary blood flow during chest compression, which in turn leads to a recovery of the spontaneous circulation, was reason enough for epinephrine to have been given its prominent role. A number of studies in the past 10 years, both randomized trials and large observational studies, have failed to show improved outcomes in patients with out-of-hospital cardiac arrest who had received epinephrine. The PARAMEDIC2 trial was published recently, with 4,015 patients receiving parenteral epinephrine and 3,999 receiving placebo. This study showed a survival benefit for epinephrine; however, there was no significant survival with good neurological outcome. The reasons for this may be related to a disturbed cerebral microcirculation and decreased blood flow in the carotid artery, and to epinephrine-mediated platelet activation, with an increased risk of thrombosis.
尽管肾上腺素在复苏医学中作为基石药物已有60多年，但直到最近其应用才得到全面研究，这可能是因为肾上腺素的益处似乎非常明显。由α-肾上腺素能受体介导的小动脉血管收缩，在胸外按压期间导致更高的冠状动脉血流量，进而导致自主循环恢复，这足以成为肾上腺素发挥突出作用的理由。在过去10年中，多项研究，包括随机试验和大型观察性研究，均未能表明接受肾上腺素治疗的院外心脏骤停患者的预后有所改善。PARAMEDIC2试验最近发表，4015例患者接受胃肠外肾上腺素治疗，3999例接受安慰剂治疗。这项研究显示肾上腺素具有生存获益；然而，在良好神经功能转归方面并无显著生存获益。其原因可能与脑微循环紊乱、颈动脉血流减少以及肾上腺素介导的血小板活化有关，血栓形成风险增加。
