Background
Cardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during
cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary
artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious.
Methods and Results
A 49-year-old patient underwent an emergency coronarography with an attempt to stent
the coronary arteries. Radiologic imaging revealed a positive methylergonovine maleate
(Methergine, Novartis Pharmaceuticals, East Hanover, NJ) test, with subocclusive CAS
in several coronary vessels leading to electromechanical dissociation. Cardiopulmonary
resuscitation was performed, and intracoronary boluses of isosorbide dinitrate were
given to treat CAS. Epinephrine/adrenaline was not administered during resuscitation.
Spontaneous circulation was obtained after cardioversion for ventricular fibrillation,
and the patient progressively regained consciousness.
Conclusion
Resuscitation guidelines do not specify the use of trinitrate derivatives in cardiac
arrest situations caused by CAS. The pros and cons of the use of nitrates and epinephrine/adrenaline
during cardiac arrest caused by CAS are analyzed in this case report.
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Article info
Publication history
Published online: September 16, 2008
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
