Impact of adrenaline on the intra-arrest haemodynamics during experimental cardiac arrest
Authors:
Škulec R. 1–3; T. Pařízek 2; D. Astapenko 2; R. Černá Pařízková 1; M. Bílská 2; T. Hovanec 4; N. Pinterová 5; A. Truhlář 1,6; V. Radochová 7; V. Černý 1,2,8,9
Authors‘ workplace:
Klinika anesteziologie, resuscitace a intenzivní medicíny, Lékařská fakulta v Hradci Králové, Univerzita Karlova a Fakultní nemocnice Hradec Králové
1; Klinika anesteziologie, perioperační a intenzivní medicíny, Fakulta zdravotnických studií, Univerzita J. E. Purkyně a Masarykova nemocnice v Ústí nad Labem
2; Zdravotnická záchranná služba Středočeského kraje, Kladno
3; Lékařská fakulta v Hradci Králové, Univerzita Karlova
4; Přírodovědecká fakulta, Univerzita Karlova
5; Zdravotnická záchranná služba Královéhradeckého kraje, Hradec Králové
6; Fakulta vojenského zdravotnictví v Hradci Králové, Univerzita obrany v Brně
7; Centrum pro výzkum a vývoj, Fakultní nemocnice Hradec Králové
8; Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Kanada
9
Published in:
Anest. intenziv. Med., 29, 2018, č. 2, s. 86-95
Category:
Overview
Objective:
Although adrenaline administration is a part of the advanced life support algorithm, its role has been questioned recently. Therefore, we conducted a study to investigate the effect of adrenaline administration on the haemodynamics during experimental cardiac arrest (CA).
Design:
Randomized, unblinded, experimental study.
Setting:
Experimental laboratory in a university hospital.
Materials and methods:
Ventricular fibrillation was induced for 15 minutes (two minutes without resuscitation attempts, three minutes of chest compressions, ten minutes of chest compressions and mechanical ventilation) in 14 anaesthetized domestic pigs. After spontaneous circulation was restored, the animals were observed for 20 minutes. Prior to CA induction, the experimental animals were randomized to receive a bolus of 15 μg/kg of adrenaline intravenously (IV) in the 5th and 10th minute of CA (group A) or to undergo cardiopulmonary resuscitation without adrenaline administration (group B). Haemodynamic variables including coronary (CoPP) and cerebral perfusion pressure (CPP) were continuously monitored throughout the protocol.
Results:
While return of spontaneous circulation was reached in all 7 group A animals, in group B it was achieved in 5 animals only (p=0.462). The observed variables except body temperature were comparable in both the groups prior to the cardiac arrest induction. Administration of adrenaline in group A resulted in a significant increase in CoPP in the first minute after both administrations compared to group B, where adrenaline was not administered (6th minute: 30.6±6.4 vs. 14.3±3.2 mm Hg, 11th minute: 29.4±8.5 vs. 12.3±2.4 mm Hg, p<0.05) with a gradual decrease to the baseline levels. A similar increase in CPP without undesirable elevation of the intracranial pressure was identified in group A.
Conclusion:
In our experimental model of CA, regular adrenaline administration resulted in a significant temporary increase in CoPP and CPP without an unfavourable increase of the intracranial pressure.
Keywords:
experimental cardiac arrest – adrenaline
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Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
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