PedsCrit Controversial Medications in Cardiac Arrest with Drs. Catherine Ross and Ryan Morgan
Apr 27, 2026
Ryan Morgan, pediatric intensivist and resuscitation scientist focused on intra-arrest physiology. Catherine Ross, pediatric critical care physician researching peri‑arrest drug strategies. They debate epinephrine dosing and tailoring by diastolic BP. They discuss bolus versus infusion tactics, vasopressin as a salvage option, inhaled nitric oxide for high pulmonary pressures, and controversies around bicarbonate and calcium use in arrest.
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Use Pre diluted Push Dose Epi As A Bridge
- Use dilute (push‑dose) epinephrine as a short-term bridge for acute hypotension when central infusions aren't yet established.
- Catherine Ross recommends pre-diluted standardized concentrations to reduce bedside mixing errors and titrate carefully to avoid extreme hypertension.
Vasopressin Offers Different Vasoconstriction Physiology
- Vasopressin acts via noncatecholamine V1 pathways, increasing SVR without cerebral vasoconstriction and can cause pulmonary vasodilation.
- Ryan Morgan and Catherine Ross see physiologic appeal especially for epinephrine nonresponders but lack definitive pediatric RCT data.
Reach For Vasopressin As A Salvage Option
- Consider vasopressin as a later, one‑time rescue agent when epinephrine cycles fail or physiologic monitoring shows no response.
- Ryan Morgan describes using vasopressin typically once, sometimes as a third‑line in hemodynamic‑directed CPR.