Adrenaline (epinephrine) should be given during Cardiopulmonary Resuscitation (CPR) for adults in cardiac arrest according to specific timelines based on whether the rhythm is shockable or non-shockable.
Adrenaline Administration for Non-Shockable Rhythms
- Timing: Administer adrenaline 1 mg intravenously (IV) or intraosseously (IO) as soon as possible after establishing that the rhythm is non-shockable (e.g., asystole or pulseless electrical activity [PEA]).
- Repeat Dose: Repeat adrenaline 1 mg IV (IO) every 3-5 minutes while Advanced Life Support (ALS) continues.
Adrenaline Administration for Shockable Rhythms
- Initial Management: For patients with a shockable rhythm (e.g., ventricular fibrillation [VF] or pulseless ventricular tachycardia [pVT]), focus initially on delivering high-quality CPR and defibrillation attempts.
- Timing: Administer adrenaline 1 mg IV (IO) after the 3rd shock if the patient remains in VF/pVT. This strategy prioritizes early defibrillation.
- Repeat Dose: Repeat adrenaline 1 mg IV (IO) every 3-5 minutes whilst ALS continues.
Summary Table
| Rhythm Type | Initial Action | Adrenaline Timing | Repeat Dose |
|---|---|---|---|
| Non-Shockable (Asystole/PEA) | Start CPR immediately | As soon as possible | 1 mg IV/IO every 3-5 minutes |
| Shockable (VF/pVT) | High-quality CPR, attempt defibrillation. Repeat defibrillation if unsuccessful | After the 3rd shock if rhythm remains shockable | 1 mg IV/IO every 3-5 minutes after the initial adrenaline dose |
Key Considerations:
- Early CPR is crucial: Regardless of rhythm, initiating high-quality CPR immediately is paramount.
- Route of administration: Intravenous (IV) access is preferred. If IV access is not readily available, use the intraosseous (IO) route.
- Continuous ALS: Adrenaline administration is one component of comprehensive Advanced Life Support (ALS) management. Continue other appropriate interventions as indicated.
- Local Guidelines: Always follow the most current guidelines and protocols established by your local resuscitation council or healthcare institution.
