Continuous Versus Bolus Adrenaline in Cardiac Arrest

Abstract

Study Objective The optimal administration strategy of adrenaline during cardiopulmonary resuscitation (CPR) remains uncertain. While current guidelines recommend intermittent bolus dosing, experimental data suggest that continuous infusion may improve cerebral perfusion and oxygenation. This abstract synthesizes recent preclinical evidence comparing continuous versus bolus adrenaline during CPR.

Methods A structured review of four controlled experimental animal studies was performed. These investigations evaluated different adrenaline administration strategies during CPR, focusing on hemodynamic parameters, coronary perfusion pressure, cerebral blood flow, and cerebral oxygenation in standardized cardiac arrest models with invasive monitoring.

Results Continuous adrenaline infusion was associated with increased cortical cerebral blood flow compared to bolus administration.[1] Furthermore, continuous administration resulted in more stable cerebral oxygenation, whereas bolus dosing produced greater fluctuations.[2] In a multicenter preclinical comparison of bolus versus continuous adrenaline delivery, continuous infusion was associated with more consistent perfusion parameters over time.[3] Importantly, repeated bolus administration demonstrated a diminishing hemodynamic response over successive CPR cycles, suggesting pharmacodynamic attenuation during prolonged resuscitation.[4]

Discussion Preclinical evidence indicates that continuous adrenaline infusion during CPR may provide more stable cerebral perfusion and mitigate the decreasing hemodynamic effect observed with repeated bolus dosing. Although clinical outcome data are lacking and translation to human resuscitation remains uncertain, these findings challenge the exclusive reliance on bolus administration and support further investigation of continuous infusion strategies in future clinical trials.