www.praktickelekarenstvi.cz e9 PRAKTICKÉ LÉKÁRENSTVÍ AKTUÁLNÍ FARMAKOTERAPIE Farmakoterapie během kardiopulmonální resuscitace Podání tekutin je doporučeno jen v případě, že možnou příčinou oběhové zástavy je hypovolemie. Závěr Evidence o farmakologii během oběhové zástavy zůstává i nadále zcela nedostatečná. U některých léků se jejich slibné účinky projevily pouze na zvířecích modelech a nebyly potvrzené ve velkých klinických studiích. Řada z testovaných léků zvýšila šanci na dosažení ROSC nebo zlepšila krátkodobé přežití, ale neovlivnila dlouhodobé přežívání či neurologický výsledek. Nezpochybnitelné důkazy nemáme ani pro základ současné farmakoterapie u srdeční zástavy – adrenalin. Je proto třeba další intenzivní výzkumné práce k nalezení optimální a důkazy podložené farmakologické léčby u srdeční zástavy. LITERATURA 1. Soar J, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support Resuscitation 2021; 161: 115–151. 2. Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD; Adult advanced life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2015; 95: 100–47. 3. Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, Perkins GD. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2010; 81(10): 1305–1352. 4. Ahlquist RP. A study of the adrenotropic receptors. Am J Physiol. 1948; 153(3): 586–600. 5. Tang W. Pulmonary ventilation/perfusion defects induced by epinephrine during cardiopulmonary resuscitation. Circulation 1991; 84(5): 2101–7. 6. Ristagno G. Effects of epinephrine and vasopressin on cerebral microcirculatory flows during and after cardiopulmonary resuscitation. Crit Care Med 2007; 35(9): 2145–2149. 7. Jacobs IG. Effect of adrenaline on survival in out-of-hospital cardiac arrest: a randomised double-blind placebo-controlled trial. Resuscitation 2011; 82(9): 1138–43. 8. Woodhouse SP. High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest. Resuscitation 1995; 30(3): 243–9. 9. Patanwala AE, Slack MK, Martin JR, et al. Effect of epinephrine on survival after cardiac arrest: A systematic review and meta-analysis. Minerva Anestesiol 2014; 80(7): 831–843. 10. Lin S, Callaway CW, Shah PS, et al. Adrenaline for out-of-hospital cardiac arrest resuscitation: A systematic review and meta-analysis of randomized controlled trials. Resuscitation 2014; 85(6): 732–740. 11. Loomba RS, Nijhawan K, Aggarwal S, et al. Increased return of spontaneous circulation at the expense of neurologic outcomes: Is prehospital epinephrine for out-of-hospital cardiac arrest really worth it? J Crit Care 2015; 30(6): 1376–1381. 12. Perkins GD, Ji C, Deakin CD, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med 2018; 379(8): 711–721. 13. Dumas F, Bougouin W, Geri G, et al. Is epinephrine during cardiac arrest associated with worse outcomes in resuscitated patients? J Am Coll Cardiol 2014; 64(22): 2360–2367. 14. Fukuda T, Ohashi-Fukuda N, Matsubara T, et al. Effect of prehospital epinephrine on out-of-hospital cardiac arrest: A report from the national out-of-hospital cardiac arrest data registry in Japan, 2011–2012. Eur J Clin Pharmacol 2016; 72(10): 1255–1264. 15. Hayashi Y, Iwami T, Kitamura T, et al. Impact of early intravenous epinephrine administration on outcomes following out-of-hospital cardiac arrest. Circ J 2012; 76(7): 1639–1645. 16. Ewy GA, Bobrow BJ, Chikani V, et al. The time dependent association of adrenaline administration and survival from out-of-hospital cardiac arrest. Resuscitation 2015; 96: 180–185. 17. Tanaka H, Takyu H, Sagisaka R, et al. Favorable neurological outcomes by early epinephrine administration within 19 minutes after EMS call for out-of-hospital cardiac arrest patients. Am J Emerg Med 2016; 34(12): 2284–2290. 18. Wenzel V. Vasopressin improves vital organ blood flow after prolonged cardiac arrest with postcountershock pulseless electrical activity in pigs. Crit Care Med 1999; 27(3): 489– 492. 19. Currigan CE. Vasoconstrictor responses to vasopressor agents in human pulmonary and radial arteries: an in vitro study. Anesthesiology 2014; 121(5): 930–6. 20. Stiell IG. Vasopressin vs. epinephrine for inhospital cardiac arrest: a randomised controlled trial. Lancet 2001; 358(9276): 105–109. 21. Callaway CW. Usefulness of vasopressin administered with epinephrine during out-of-
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