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Intracardiac Epinephrine - #PHARMFAX

Intracardiac epinephrine 1 mg is injected directly into the ventricle during open chest resuscitative thoracotomy.

 


Intracardiac epinephrine 1 mg is given directly into the ventricle during open chest resuscitative thoracotomy. In the early 1900s, intracardiac epinephrine was used for the treatment heart wounds and anesthesia-induced cardiac arrest. We no longer use intracardiac epinephrine for closed chest ACLS since there is no benefit over other routes of administration and with the introduction of the defibrillator. There Intracardiac epinephrine also has the risk of coronary artery laceration, pericardial effusions, and cardiac tamponade.


The only indication for intracardiac epinephrine is during resuscitative thoracotomy for a traumatic arrest. Thats when the trauma surgeon makes an incision through the chest cavity to access the heart to perform a cardiac massage. Intracardiac epinephrine increases coronary and cerebral perfusion pressure. The 2010 ACLS Guidelines reviewed the literature at the time showing resuscitative thoracotomy having a 7.8% chance of survival in trauma victims who would've otherwise had 100% mortality.


You can give either the 1mg/10 mL from the carboject or 1 mg/mL from a vial. No specialized needle is needed in the setting of an open thoracotomy. Traumatic arrests are associated with low survivability, but intracardiac epinephrine comes to mind if we're heading towards opening the chest.


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