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
; Götberg, Matthias
LU
; Sparv, David
LU
; Erlinge, David
LU
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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/5085283
- author
- Wagner, Henrik
LU
; Götberg, Michael
; Hardig, Bjarne Madsen
LU
; Rundgren, Malin
LU
; Carlson, Jonas
LU
; Götberg, Matthias
LU
; Sparv, David
LU
; Erlinge, David
LU
and Olivecrona, Göran
LU
- organization
- publishing date
- 2014
- 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
- 2024-10-10 16:59:06
@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}},
keywords = {{Cardiac arrest; Mechanical chest compressions; Epinephrine}},
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}},
}