Is more epi better?

Epinephrine is the primary drug administered per ACLS protocol to patients in asystole, PEA, and ventricular fibrillation/ pulseless V-tach. Epinephrine will increase blood pressure and coronary perfusion throughout CPR via alpha-1-adrenoceptor agonist effects. The dose, timing and indications for epinephrine use are supported based on animal data. Recent studies question whether or not epinephrine provides any overall benefit for human patients. A randomized controlled trial shows that epinephrine for out-of-hospital cardiac arrest will increase the rate of pulse return, however, it doesn't considerably alter longer-term survival. Large controlled studies suggest that, despite increases in pulse return, epinephrine reduces long-term survival (to hospital discharge.) The damaging effects were greatest in patients found in ventricular fibrillation. Laboratory information suggest that harmful epinephrine-induced reductions in microvascular blood flow throughout the arrest, and in the post-arrest patient, might offset the useful effects epinephrine-induced increase in blood pressure throughout CPR.