Adrenaline
Class
- a catecholamine
Mechanism of Action
- direct acting sympatheomimetic -> alpha & beta agonist
- low doses -> beta-effects -> increase HR and Q
- higher doses -> alpha-effects
- maintains coronary & cerebral blood flow
Pharmaceutics
- opaque ampoule (1:1000), mini jets
Dose
- bolus -> 0.01 -> 0.5mcg/kg/min IV (give through CVL for safety)
Indications
- Anaphylactic/oid shock
- Asystole
- Low cardiac output states
- Glaucoma
- Local vasoconstictor
- Added to LA to increase duration of action
Adverse Effects
- hypokalaemia
- hypophosphataemia
- hyperglycaemia
- lactataemia
- caution with MAO-I
PK
- Absorption – IV, IM, nebulised, topical
- Distribution –
- Metabolism – hepatic + adrenergic nerve endings (COMT and MAO)
- Elimination – inactive products appear in urine
Evidence
CAT Study Investigators (2009 – Int Care Med)
- Australasian Trial
- RCT looking at Noradrenaline vs Adrenaline to treat hypotension (sepsis or cvs failure)
- n = 208
- -> no significant difference in mortality, LOS, ventilation, shock duration
- -> adrenaline – transient lactic acidosis, hyperglycaemia, tachycardia
Annane (2007, Lancet)
- MRCT
- noradrenaline vs adrenaline in septic shock
- n = 330
- -> no significant difference in mortality, BP, time to haemodynamic stability, duration of vasopressor therapy, time to organ dysfunction resolution, adverse effects
SUMMARY
Myburg (2008) – “The case for Adrenaline” Critical Care and Resuscitation, Volume 10 (3) page 178
- poor quality evidence
-> no difference in outcomes
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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