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Repeated epinephrine doses during prolonged cardiopulmonary resuscitation have limited effects on myocardial blood flow: a randomized porcine study

Wagner, Henrik LU ; Götberg, Michael ; Hardig, Bjarne Madsen LU ; Rundgren, Malin LU ; Carlson, Jonas LU orcid ; Götberg, Matthias LU ; Sparv, David LU ; Erlinge, David LU orcid and Olivecrona, Göran LU (2014) In BMC Cardiovascular Disorders 14.
Abstract
Background: 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). Methods: 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... (More)
Background: 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). Methods: 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. Result: Compared to the control group, maximum peak of CPP (P-max) after injection 1 and 2 was significantly increased in the EPI-all group (p = 0.022, p = 0.016), in EPI 0.02-group after injection 2 and 3 (p = 0.023, p = 0.027) and in EPI 0.03-group after injection 1 (p = 0.013). At P-max, APV increased only after first injection in both the EPI-all and the EPI 0.03-group compared with the control group (p = 0.011, p = 0.018). There was no statistical difference of AMSA at any P-max. Seven out of 12 animals (58%) in each EPI-group versus 10 out of 12 (83%) achieved spontaneous circulation after CA. Conclusion: In an experimental CA-CPR pig model repeated doses of intravenous EPI results in a significant increase in APV only after the first injection despite increments in CPP also during the following 2 injections indicating inappropriate changes in coronary vascular resistance during subsequent EPI administration. (Less)
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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Mechanical chest compressions, Epinephrine
in
BMC Cardiovascular Disorders
volume
14
article number
199
publisher
BioMed Central (BMC)
external identifiers
  • wos:000347351600001
  • scopus:84964314427
  • pmid:25528598
ISSN
1471-2261
DOI
10.1186/1471-2261-14-199
project
Helsingborg Resuscitation and Cardiovascular Research Group
language
English
LU publication?
yes
id
9a4cd130-cef6-4674-a984-8bb18f46eb51 (old id 5085283)
date added to LUP
2016-04-01 14:26:30
date last changed
2021-08-18 03:17:50
@article{9a4cd130-cef6-4674-a984-8bb18f46eb51,
  abstract     = {Background: 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). Methods: 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. Result: Compared to the control group, maximum peak of CPP (P-max) after injection 1 and 2 was significantly increased in the EPI-all group (p = 0.022, p = 0.016), in EPI 0.02-group after injection 2 and 3 (p = 0.023, p = 0.027) and in EPI 0.03-group after injection 1 (p = 0.013). At P-max, APV increased only after first injection in both the EPI-all and the EPI 0.03-group compared with the control group (p = 0.011, p = 0.018). There was no statistical difference of AMSA at any P-max. Seven out of 12 animals (58%) in each EPI-group versus 10 out of 12 (83%) achieved spontaneous circulation after CA. Conclusion: In an experimental CA-CPR pig model repeated doses of intravenous EPI results in a significant increase in APV only after the first injection despite increments in CPP also during the following 2 injections indicating inappropriate changes in coronary vascular resistance during subsequent EPI administration.},
  author       = {Wagner, Henrik and Götberg, Michael and Hardig, Bjarne Madsen and Rundgren, Malin and Carlson, Jonas and Götberg, Matthias and Sparv, David and Erlinge, David and Olivecrona, Göran},
  issn         = {1471-2261},
  language     = {eng},
  publisher    = {BioMed Central (BMC)},
  series       = {BMC Cardiovascular Disorders},
  title        = {Repeated epinephrine doses during prolonged cardiopulmonary resuscitation have limited effects on myocardial blood flow: a randomized porcine study},
  url          = {https://lup.lub.lu.se/search/files/3977417/7761615},
  doi          = {10.1186/1471-2261-14-199},
  volume       = {14},
  year         = {2014},
}