Towards cardiopulmonary resuscitation without vasoactive drugs

Curr Opin Crit Care. 2014 Jun;20(3):234-41. doi: 10.1097/MCC.0000000000000082.


Purpose of review: Whereas there is clear evidence for improved survival with cardiopulmonary resuscitation (CPR) and defibrillation during cardiac arrest management, there is today lacking evidence that any of the recommended and used drugs lead to any long-term benefit for the patients. In this review, we try to discuss our current view on why advanced life support (ALS) today can be performed without the use of drugs, and instead gain all focus on improving the tasks we know improve survival: CPR and defibrillation.

Recent findings: Previous and recent cardiac arrest drug studies have been reviewed. These are mostly consisting of retrospective register data, some experimental data and a few new randomized trials. The alternative drug-free ALS concept is also discussed with relevant studies.

Summary: There is currently no evidence to support any specific drugs during cardiac arrest. Good-quality CPR, early defibrillation and goal-directed postresuscitation care is more important. Healthcare systems should not prioritize implementation of unproven drugs before good quality of care can be documented. More drug studies are indeed required, and future research needs to incorporate better diagnostic tools to test more specific and tailored therapies that account for underlying causes and individual responsiveness.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Arrhythmia Agents / administration & dosage*
  • Cardiopulmonary Resuscitation* / methods
  • Cardiopulmonary Resuscitation* / trends
  • Electric Countershock / methods*
  • Electric Countershock / trends
  • Emergency Medical Services*
  • Epinephrine / administration & dosage*
  • Health Services Research
  • Heart Arrest / mortality
  • Heart Arrest / therapy*
  • Humans
  • Life Support Care
  • Outcome and Process Assessment, Health Care
  • Randomized Controlled Trials as Topic
  • Spectrum Analysis
  • Survival Rate
  • Vasoconstrictor Agents / administration & dosage*


  • Anti-Arrhythmia Agents
  • Vasoconstrictor Agents
  • Epinephrine