The Effects of Graded Doses of Epinephrine on Regional Myocardial Blood Flow During Cardiopulmonary Resuscitation In Swine (original) (raw)
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BMC cardiovascular disorders, 2014
In current guidelines, prolonged cardiopulmonary resuscitation (CPR) mandates administration of repeated intravenous epinephrine (EPI) doses. This porcine study simulating a prolonged CPR-situation in the coronary catheterisation laboratory, explores the effect of EPI-administrations on coronary perfusion pressure (CPP), continuous coronary artery flow average peak velocity (APV) and amplitude spectrum area (AMSA). Thirty-six pigs were randomized 1:1:1 to EPI 0.02 mg/kg/dose, EPI 0.03 mg/kg/dose or saline (control) in an experimental cardiac arrest (CA) model. During 15 minutes of mechanical chest compressions, four EPI/saline-injections were administered, and the effect on CPP, APV and AMSA were recorded. Comparisons were performed between the control and the two EPI-groups and a combination of the two EPI-groups, EPI-all. Compared to the control group, maximum peak of CPP (Pmax) after injection 1 and 2 was significantly increased in the EPI-all group (p = 0.022, p = 0.016), in EPI...
Critical Care, 2020
Background Despite controversies, epinephrine remains a mainstay of cardiopulmonary resuscitation (CPR). Recent animal studies have suggested that epinephrine may decrease cerebral blood flow (CBF) and cerebral oxygenation, possibly potentiating neurological injury during CPR. We investigated the cerebrovascular effects of intravenous epinephrine in a swine model of pediatric in-hospital cardiac arrest. The primary objectives of this study were to determine if (1) epinephrine doses have a significant acute effect on CBF and cerebral tissue oxygenation during CPR and (2) if the effect of each subsequent dose of epinephrine differs significantly from that of the first. Methods One-month-old piglets (n = 20) underwent asphyxia for 7 min, ventricular fibrillation, and CPR for 10–20 min. Epinephrine (20 mcg/kg) was administered at 2, 6, 10, 14, and 18 min of CPR. Invasive (laser Doppler, brain tissue oxygen tension [PbtO2]) and noninvasive (diffuse correlation spectroscopy and diffuse op...
2013
Background: The ResQPod ® , an impedance threshold device (ITD), was developed to augment cardiac output during cardiopulmonary resuscitation (CPR). If an ITD used with CPR does in fact increase venous return and cardiac output, then the use of such a device should increase the maximum concentration (Cmax) of epinephrine in the plasma and decrease the time to maximum concentration (Tmax). To our knowledge, no studies have investigated the pharmacokinetics of epinephrine during CPR while using the ResQPod ®. The purpose of this study was to determine the effect of the ResQPod ® on plasma concentrations of epinephrine in swine undergoing CPR for cardiac arrest. Methods: This was a prospective, experimental, between-subjects design. Twelve Yorkshire-cross swine were assigned one of two groups: CPR with the ResQPod ® and CPR without the use of the ResQPod ®. Pigs were administered potassium chloride by intravenous (IV) route to achieve cardiac arrest. After two minutes of CPR, epinephrine was administered by IV push. Blood samples were collected at 0, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 7.5 and 10 minutes after the injection of epinephrine. Results: Results are reported in means and standard deviations respectively. Use of the ResQPod ® resulted in lower Cmax than control (219.34 ± 110.59 ng/mL; 471.53 ± 349.71 ng/mL). Tmax was longer when using ResQPod ® compared to the control group (4.75 ± 1.54 minutes; 3.42 ± 1.11 minutes). Although there were differences between the groups, the results were not statistically significant relative to Cmax and Tmax (p=0.276). Conclusion: It appears the ResQPod ® does not increase the delivery of epinephrine during CPR. More research is needed to evaluate the effects of the ResQPod ® on epinephrine metabolite levels and on survivability. If the ResQPod ® boosts the circulation of epinephrine to end organs, it is reasonable to predict that epinephrine metabolite concentrations and survivability would be higher than a control group.
Annals of Emergency Medicine, 1988
Our study compared the effect of high-dose epinephrine with the pure alphaagonist phenylephrine on regional myocardial blood flow (MBF), myocardial oxygen delivery (MD02), myocardial oxygen consumption (MV02), and defibrillation rates during CPR. Fifteen swine weighing more than 15 kg were instrumented for measurement of regional MBF using radiolabeled tracer microspheres. Measurements of regional MBF, MD02, and MVO 2 were made during normal sinus rhythm. Ventricular fibrillation was induced and persisted for ten minutes. CPR was begun using a pneumatic compression device. Regional MBF, MD02, and MVO 2 were measured during CPR. Following three minutes of CPR, animals (N= 15) were allocated to one of three groups (n = 5): Group 1, epinephrine 0.2 mg/kg; Group 2, phenylephrine 0.1 mg/kg; or Group 3, phenylephrine 1.0 mg/kg. Measurements of regional MBF, MDO 2, and MVO 2 were repeated after drug administration. Extraction ratios, defined as MVOJMDO 2, were calculated during normal sinus rhythm, CPR, and after drug administration. Defibrillation was attempted 31/2 minutes after drug administration. There was no significant difference in MBE MDO 2, MVO 2, and extraction ratio during normal sinus rhythm and CPR for any of the groups. Total MBF following drug administration was 67.2 +_ 49.4 mL/min/lO0 g for the group receiving epinephrine 0.2 mg/kg; 7.0 ± 7.1 mL/min/IO0 g for the group receiving phenylephrine 0.I mg/kg; and 36.7 ± 21.1 mL/min/lO0 g for the group receiving phenylephrine 1.0 rag~ kg. The extraction ratios for animals receiving epinephrine 0.2 mg/kg, phenylephrine 0.1 rag~ g, and phenylephrine 1.0 mg/kg were 76.6 ± 10.5%, 94.6 ± 4.0%, and 90.7 + 7.5%, respectively. The extraction ratio for the group receiving epinephrine was significantly better than both phenylephrine groups (P = .01). Defibrillation rates for each group were 80%, 0%, and 0%, respectively. Our results suggest that epinephrine in doses higher than are currently recommended improves MBF and oxygen extraction ratios during CPR when compared with the pure alpha-agonist phenylephrine. /Brown CG, Taylor RB, Werman HA, Luu T, Ashton J, Hamlin RL: Myocardial oxygen delivery~consumption during cardiopulmonary resuscitation: A comparison of epinephrine and phenylephrine. Ann Emerg Med April 1988;17:302-308.]
International Journal of Environmental Research and Public Health
Severe neurological impairment was more prevalent in cardiac arrest survivors who were administered epinephrine than in those administered placebo in a randomized clinical trial; short-term reduction of brain tissue O2 tension (PbtO2) after epinephrine administration in swine following a short duration of untreated cardiac arrest has also been reported. We investigated the effects of epinephrine administered during cardiopulmonary resuscitation (CPR) on cerebral oxygenation after restoration of spontaneous circulation (ROSC) in a swine model with a clinically relevant duration of untreated cardiac arrest. After 7 min of ventricular fibrillation, 24 pigs randomly received either epinephrine or saline placebo during CPR. Parietal cortex measurements during 60-min post-resuscitation period showed that the area under the curve (AUC) for PbtO2 was smaller in the epinephrine group than in the placebo group during the initial 10-min period and subsequent 50-min period (both p < 0.05). T...
Critical Care, 2021
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Resuscitation, 2003
Introduction: Epinephrine (adrenaline) and vasopressin are used currently to improve myocardial blood flow (MBF) during cardiac arrest. Angiotensin II has also been shown to improve MBF during CPR. We explored the effects of angiotensin II or epinephrine alone, and the combination of angiotensin with epinephrine, on myocardial and cerebral blood flows in a swine model of cardiac arrest. Methods: Swine were instrumented for regional blood flow measurements. Ventricular fibrillation was induced and CPR begun. Angiotensin II 50 mcg/kg (ANG), epinephrine 0.02 mg/kg (EPI) or the combination (ANG'/EPI) was administered. Blood flow was measured during baseline normal sinus rhythm (NSR), before (CPR) and after drug administration (CPR'/ DRUG), and post reperfusion return of spontaneous circulation (ROSC). Results: All groups had a significant increase in MBF during CPR following drug administration (P B/0.05).