During a code, why is epinephrine given?

• A. It will prevent gastric distention from overventilation.
• B. It will treat any potential anaphylactic reaction.
• C. It dries secretions to aid intubation.
• D. It vasoconstricts peripheral circulation and shunts blood to central circulation.

Answer: (D)

In a code, the priority is to maximize perfusion to the heart and brain during chest compressions. Epinephrine is given for its alpha-adrenergic vasoconstriction, which raises systemic vascular resistance and increases aortic diastolic pressure. This boost elevates coronary and cerebral perfusion pressures, improving the chances of return of spontaneous circulation. In effect, it concentrates blood flow toward the central circulation when peripheral blood flow is limited by CPR. The beta effects can help support heart rate and contractility, but the key reason here is to enhance central perfusion pressures. The other options describe effects that aren’t the primary goal during CPR—gastric distention prevention, secretion drying, or treating anaphylaxis—so they don’t explain why epinephrine is used in this setting.