Adrenaline has a limited effect on myocardial microvascular blood flow : A randomised experimental study in a porcine cardiac arrest model
(2025) In Resuscitation Plus 22.- Abstract
Background: Adrenaline (ADR) is a cornerstone of advanced life support (ALS) in cardiac arrest (CA), although its neurologically favourable survival outcomes remain unclear. ADR increases coronary perfusion pressure (CPP), with levels >15 mmHg associated with successful defibrillation. This study aimed to elucidate the relationship between ADR, myocardial microvascular blood flow, and resuscitation outcomes using a porcine CA model simulating refractory ventricular fibrillation (VF). Methods: This study involved 24 domestic pigs. After instrumentation, intubation, and baseline measurements, the animals were randomised into the ADR or control (saline) groups. VF was induced, and cardiopulmonary resuscitation was initiated using... (More)
Background: Adrenaline (ADR) is a cornerstone of advanced life support (ALS) in cardiac arrest (CA), although its neurologically favourable survival outcomes remain unclear. ADR increases coronary perfusion pressure (CPP), with levels >15 mmHg associated with successful defibrillation. This study aimed to elucidate the relationship between ADR, myocardial microvascular blood flow, and resuscitation outcomes using a porcine CA model simulating refractory ventricular fibrillation (VF). Methods: This study involved 24 domestic pigs. After instrumentation, intubation, and baseline measurements, the animals were randomised into the ADR or control (saline) groups. VF was induced, and cardiopulmonary resuscitation was initiated using continuous mechanical chest compressions and ventilation. ADR or saline was administered following ALS guidelines. After 21 min of ALS, defibrillation was performed. Continuous measurements of arterial and venous blood pressures using an electrocardiogram and index of myocardial resistance (IMR) and transit mean time (Tmn) 1 min before and after each injection or peak blood pressure were recorded and compared between the groups. CPP–IMR, amplitude spectrum area (AMSA)–IMR, CPP–Tmn, and AMSA–Tmn correlations were assessed. Results: Compared with six animals in the control group, three in the ADR group achieved a return of spontaneous circulation. No difference was observed in IMR or AMSA; however, significant increases in CPP and arterial end-diastolic blood pressure were observed at several time points. Tmn differed between groups only at two time points. Conclusion: Repeated ADR doses during prolonged ALS simulating refractory VF did not improve myocardial microvascular blood flow, as measured using IMR, despite leading to an increase in CPP.
(Less)
- author
- Wagner, Henrik LU ; Mlček, Mikuláš ; Krupičková, Petra ; Popkova, Michaela ; Mejstrik, Alan ; Boucek, Tomas ; Michálek, Pavel ; Kittnar, Otomar and Belohlavek, Jan
- organization
- publishing date
- 2025
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adrenaline, Advanced life support, Cardiac arrest, Cardiopulmonary resuscitation, Index of myocardial resistance, Porcine, Ventricular fibrillation
- in
- Resuscitation Plus
- volume
- 22
- article number
- 100893
- publisher
- Elsevier
- external identifiers
-
- scopus:85217805124
- pmid:40034872
- ISSN
- 2666-5204
- DOI
- 10.1016/j.resplu.2025.100893
- language
- English
- LU publication?
- yes
- id
- 279f7477-03ff-4a43-80f4-b44882667031
- date added to LUP
- 2025-06-19 11:27:08
- date last changed
- 2025-07-17 14:32:06
@article{279f7477-03ff-4a43-80f4-b44882667031,
abstract = {{<p>Background: Adrenaline (ADR) is a cornerstone of advanced life support (ALS) in cardiac arrest (CA), although its neurologically favourable survival outcomes remain unclear. ADR increases coronary perfusion pressure (CPP), with levels >15 mmHg associated with successful defibrillation. This study aimed to elucidate the relationship between ADR, myocardial microvascular blood flow, and resuscitation outcomes using a porcine CA model simulating refractory ventricular fibrillation (VF). Methods: This study involved 24 domestic pigs. After instrumentation, intubation, and baseline measurements, the animals were randomised into the ADR or control (saline) groups. VF was induced, and cardiopulmonary resuscitation was initiated using continuous mechanical chest compressions and ventilation. ADR or saline was administered following ALS guidelines. After 21 min of ALS, defibrillation was performed. Continuous measurements of arterial and venous blood pressures using an electrocardiogram and index of myocardial resistance (IMR) and transit mean time (Tmn) 1 min before and after each injection or peak blood pressure were recorded and compared between the groups. CPP–IMR, amplitude spectrum area (AMSA)–IMR, CPP–Tmn, and AMSA–Tmn correlations were assessed. Results: Compared with six animals in the control group, three in the ADR group achieved a return of spontaneous circulation. No difference was observed in IMR or AMSA; however, significant increases in CPP and arterial end-diastolic blood pressure were observed at several time points. Tmn differed between groups only at two time points. Conclusion: Repeated ADR doses during prolonged ALS simulating refractory VF did not improve myocardial microvascular blood flow, as measured using IMR, despite leading to an increase in CPP.</p>}},
author = {{Wagner, Henrik and Mlček, Mikuláš and Krupičková, Petra and Popkova, Michaela and Mejstrik, Alan and Boucek, Tomas and Michálek, Pavel and Kittnar, Otomar and Belohlavek, Jan}},
issn = {{2666-5204}},
keywords = {{Adrenaline; Advanced life support; Cardiac arrest; Cardiopulmonary resuscitation; Index of myocardial resistance; Porcine; Ventricular fibrillation}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Resuscitation Plus}},
title = {{Adrenaline has a limited effect on myocardial microvascular blood flow : A randomised experimental study in a porcine cardiac arrest model}},
url = {{http://dx.doi.org/10.1016/j.resplu.2025.100893}},
doi = {{10.1016/j.resplu.2025.100893}},
volume = {{22}},
year = {{2025}},
}