#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

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


Sources

1. Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD; Adult advanced life support section Collaborators. European Resuscitation Council Guidelines for Resuscitation 2015 Section 3. Adult advanced life support. Resuscitation. 2015;95:100–147.

2. Kaiser GM, Frühauf NR. Method of intracranial pressure monitoring and cerebrospinal fluid sampling in swine. Lab Anim. 2007;41:80–85.

3. Meaney PA, Bobrow BJ, Mancini ME, Christenson J, de Caen AR, Bhanji F, Abella BS, Kleinman ME, Edelson DP, Berg RA, Aufderheide TP, Menon V, Leary M; CPR Quality Summit Investigators, the American Heart Association Emergency Cardiovascular Care Committee, and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation. 2013;128:417–435.

4. Michael JR, Guerci AD, Koehler RC, Shi AY, Tsitlik J, Chandra N, Niedermeyer E, Rogers MC, Traystman RJ, Weisfeldt ML. Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs. Circulation. 198469:822–835.

5. Paradis NA, Martin GB, Rivers EP, Goetting MG, Appleton TJ, Feingold M, Nowak RM. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA. 1990;263:1106–1113.

6. Friess SH, Sutton RM, French B, Bhalala U, Maltese MR, Naim MY, Bratinov G, Arciniegas Rodriguez S, Weiland TR, Garuccio M, Nadkarni VM, Becker LB, Berg RA. Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation. Resuscitation. 2014;85:1298–1303.

7. Sutton RM, Friess SH, Maltese MR, Naim MY, Bratinov G, Weiland TR, Garuccio M, Bhalala U, Nadkarni VM, Becker LB, Berg RA. Hemodynamic-directed cardiopulmonary resuscitation during in-hospital cardiac arrest. Resuscitation. 2014;85:983–986.

8. Sutton RM, Friess SH, Bhalala U, Maltese MR, Naim MY, Bratinov G, Niles D, Nadkarni VM, Becker LB, Berg RA. Hemodynamic directed CPR improves short-term survival from asphyxia-associated cardiac arrest. Resuscitation. 2013;84:696–701.

9. Morgan RW, Kilbaugh TJ, Shoap W, Bratinov G, Lin Y, Hsieh TC, Nadkarni VM, Berg RA, Sutton RM; Pediatric Cardiac Arrest Survival Outcomes PiCASO Laboratory Investigators. A hemodynamic-directed approach to pediatric cardiopulmonary resuscitation (HD-CPR) improves survival. Resuscitation. 2017;111:41–47.

10. Friess SH, Sutton RM, Bhalala U, Maltese MR, Naim MY, Bratinov G, Weiland TR, 3rd, Garuccio M, Nadkarni VM, Becker LB, Berg RA. Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest. Crit Care Med. 2013;41:2698–2704.

11. Ditchey RV, Lindenfeld J. Failure of epinephrine to improve the balance between myocardial oxygen supply and demand during closed-chest resuscitation in dogs. Circulation. 1988;78:382–389.

12. Sun S, Tang W, Song F, Yu T, Ristagno G, Shan Y, Weng Y, Weil MH. The effects of epinephrine on outcomes of normothermic and therapeutic hypothermic cardiopulmonary resuscitation. Crit Care Med. 2010;38:2175–2180.

13. Ristagno G, Tang W, Sun S, Weil MH. Cerebral cortical microvascular flow during and following cardiopulmonary resuscitation after short duration of cardiac arrest. Resuscitation. 2008;77:229–234.

14. Burnett AM, Segal N, Salzman JG, McKnite MS, Frascone RJ. Potential negative effects of epinephrine on carotid blood flow and ETCO2 during active compression-decompression CPR utilizing an impedance threshold device. Resuscitation. 2012;83:1021–1024.

15. Rivers EP, Wortsman J, Rady MY, Blake HC, McGeorge FT, Buderer NM. The effect of the total cumulative epinephrine dose administered during human CPR on hemodynamic, oxygen transport, and utilization variables in the postresuscitation period. Chest. 1994;106:1499–1507.

16. Lin S, Callaway CW, Shah PS, Wagner JD, Beyene J, Ziegler CP, Morrison LJ. Adrenaline for out-of-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials. Resuscitation. 2014;85:732–740.

17. Morales-Cané I, Valverde-León MD, Rodríguez-Borrego MA. Epinephrine in cardiac arrest: systematic review and meta-analysis. Rev Lat Am Enfermagem. 2016;24:e2821.

18. Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, Miyazaki S. Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA. 2012;307:1161–1168.

19. Nakahara S, Tomio J, Takahashi H, Ichikawa M, Nishida M, Morimura N, Sakamoto T. Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study. BMJ. 2013;347:f6829.

20. Dumas F, Bougouin W, Geri G, Lamhaut L, Bougle A, Daviaud F, Morichau-Beauchant T, Rosencher J, Marijon E, Carli P, Jouven X, Rea TD, Cariou A. Is epinephrine during cardiac arrest associated with worse outcomes in resuscitated patients? J Am Coll Cardiol. 2014;64:2360–2367.

21. Fukuda T, Grossestreuer A, Holmberg M, Kukita I, Donnino M. Abstract 15643: Early versus Non-Early Administration of Epinephrine After Out-of-Hospital Cardiac Arrest With Non-Shockable Rhythm: A Population-Based Cohort Study. Circulation. 2017;136:A15643.

22. Fukuda T, Kondo Y, Hayashida K, Sekiguchi H, Kukita I. Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest. Eur Heart J Cardiovasc Pharmacother. 2017 Jul 11 [Epub ahead of print].

23. Funada A, Goto Y, Tada H, Yamagishi M. Abstract 15244: Effects of Prehospital Epinephrine Administration on Neurologically Intact Survival in Bystander-Witnessed Out-of-Hospital Cardiac Arrest Patients With Initial Non-Shockable Rhythm: Based on Emergency Medical Service Response Time. Circulation. 2017;136:A15244.

24. Redding JS, Pearson JW. Resuscitation from ventricular fibrillation. Drug therapy. JAMA. 1968;203:255–260.

25. Heidenreich JW, Berg RA, Higdon TA, Ewy GA, Kern KB, Sanders AB. Rescuer fatigue: standard versus continuous chest-compression cardiopulmonary resuscitation. Acad Emerg Med. 2006;13:1020–1026.

26. Sanders AB, Kern KB, Atlas M, Bragg S, Ewy GA. Importance of the duration of inadequate coronary perfusion pressure on resuscitation from cardiac arrest. J Am Coll Cardiol. 1985;6:113–118.

27. Truhlar A. Terlipressin/adrenaline is better than adrenaline alone in a porcine model of prolonged ventricular fibrillation. A randomized controlled study. Signa vitae. 2012;7:10–16.

28. Wang CH, Huang CH, Chang WT, Tsai MS, Yu PH, Wu YW, Hung KY, Chen WJ. The influences of adrenaline dosing frequency and dosage on outcomes of adult in-hospital cardiac arrest: A retrospective cohort study. Resuscitation. 2016;103:125–130.

29. Hoyme DB, Patel SS, Samson RA, Raymond TT, Nadkarni VM, Gaies MG, Atkins DL; American Heart Association Get With the Guidelines–Resuscitation Investigators. Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest. Resuscitation. 2017;117:18–23.

30. Warren SA, Huszti E, Bradley SM, Chan PS, Bryson CL, Fitzpatrick AL, et al. Adrenaline (epinephrine) dosing period and survival after in-hospital cardiac arrest: A retrospective review of prospectively collected data. Resuscitation. 2014;85:350–358.

31. Sehra R, Underwood K, Checchia P. End tidal CO2 is a quantitative measure of cardiac arrest. Pacing Clin Electrophysiol. 2003;26(1 Pt 2):515–517.

Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#