Administering high doses of drugs like Epinephrine, Atropine, and Vasopressin has become the standard of care for Advanced Cardiac Life Support. In theory, it makes sense to “jump start” the body by giving extra-high doses of stress hormones. We all know of a case or two when the patient “came around” after some Epinephrine or Atropine. How much evidence is behind this practice? Not too much.

According to the paper published in JAMA, IV drugs during life support do not improve long term survival (survival to hospital discharge) or the neurological outcome. Short term survival (survival to ICU admission), though, was better when IV drugs were given.

Is it really surprising? Not if you think about it. If it takes an industrial dose of stress hormone to bring somebody back, the degree of the physiological derangement is likely too profound for the patient to survive to discharge. Unless there is an identifiable and correctable cause of the cardiovascular collapse, IV drugs, no matter in what doses, will unlikely change the outcome. Giving IV drugs might buy you some time to try to stabilize the patient, and that would be the argument to continue the current practice.

This is a single-center study with all it’s inherit limitations. More evidence is needed before the change of practice is considered. Meanwhile, the business as usual – push those drugs to jump start the body.