The importance of Dopamine usage after the return of spontaneous circulation at the prehospital level

Abstract

Sudden cardiac arrest is the leading cause of death in the world, accounting for 15-20% of all deaths. One of the biggest challenges when maintaining the stability of the patient's condition until hospital conditions is the occurrence of hypotension immediately after the return of spontaneous circulation (ROSC). In case of hypotension, the drugs of choice are vasopressors and inotropes. The Department of Emergency Medicine Belgrade has at its disposal Dopamine, a vasoactive, inotropic drug whose importance and use during hypotension after the establishment of spontaneous circulation (ROSC) in a patient who experienced cardiac arrest are described through a case report. Case report: a 78-year-old man, after severe abdominal pain and black copious stools followed by hemodynamic instability, experiences cardiac arrest. After all measures of cardiocerebral pulmonary resuscitation (CPR) have been taken, cardiac function is restored, but hemodynamic instability persists. The application of Dopamine infusion leads to hemodynamic optimization of the patient and transport to the on-call health facility, where the patient is placed alive, hemodynamically stable, in the intensive care unit. Conclusion: Given that the occurrence of hypotension after ROSC is frequent (it occurs in as many as 47% of cases), while on the other hand, the availability of vasopressors and inotropes at the pre-hospital level, which would treat this hypotension, is limited, it is necessary to note the importance of the use of these drugs and increase the availability of them to doctors in emergency medical services. Applying vasoactive support pre-hospital would lead to easier hemodynamic optimization of already vitally endangered and unstable patients for transport to health institutions.

Keywords

• cardiocerebral pulmonary resuscitation
• vasoactive drugs
• dopamine