Effect of standard doses of epinephrine on myocardial oxygen delivery and utilization during cardiopulmonary resuscitation

Brown, Charles G.; Taylor, Ronald B.; Werman, Howard A.; Luu, Tuan; Spittler, Genevieve; Hamlin, Robert L.

doi:10.1097/00003246-198805000-00013

Cited by 44 publications

(6 citation statements)

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“…This investigation was an observational study in which the first dose of epinephrine was provided after 2 min of chest compressions, consistent with the published mean time to epinephrine administration for pediatric in-hospital cardiac arrests [ 42 ], rather than after 4 min as suggested by international guidelines. Similarly, although international guidelines recommend epinephrine doses of 10 mcg/kg in humans, this investigation used a dose of 20 mcg/kg, which is the standard swine dose for CPR studies over the last 40 years in many laboratories in the USA and Europe [ 74 – 78 ], although a few leading swine CPR investigators have used doses of 30–45 mcg/kg [ 18 , 79 , 80 ]. Because of the observational nature of this study, there was no placebo group.…”

Section: Discussionmentioning

confidence: 99%

Epinephrine’s effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

Mavroudis

Morgan

et al. 2020

Crit Care

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Background Despite controversies, epinephrine remains a mainstay of cardiopulmonary resuscitation (CPR). Recent animal studies have suggested that epinephrine may decrease cerebral blood flow (CBF) and cerebral oxygenation, possibly potentiating neurological injury during CPR. We investigated the cerebrovascular effects of intravenous epinephrine in a swine model of pediatric in-hospital cardiac arrest. The primary objectives of this study were to determine if (1) epinephrine doses have a significant acute effect on CBF and cerebral tissue oxygenation during CPR and (2) if the effect of each subsequent dose of epinephrine differs significantly from that of the first. Methods One-month-old piglets (n = 20) underwent asphyxia for 7 min, ventricular fibrillation, and CPR for 10–20 min. Epinephrine (20 mcg/kg) was administered at 2, 6, 10, 14, and 18 min of CPR. Invasive (laser Doppler, brain tissue oxygen tension [PbtO2]) and noninvasive (diffuse correlation spectroscopy and diffuse optical spectroscopy) measurements of CBF and cerebral tissue oxygenation were simultaneously recorded. Effects of subsequent epinephrine doses were compared to the first. Results With the first epinephrine dose during CPR, CBF and cerebral tissue oxygenation increased by > 10%, as measured by each of the invasive and noninvasive measures (p < 0.001). The effects of epinephrine on CBF and cerebral tissue oxygenation decreased with subsequent doses. By the fifth dose of epinephrine, there were no demonstrable increases in CBF of cerebral tissue oxygenation. Invasive and noninvasive CBF measurements were highly correlated during asphyxia (slope effect 1.3, p < 0.001) and CPR (slope effect 0.20, p < 0.001). Conclusions This model suggests that epinephrine increases CBF and cerebral tissue oxygenation, but that effects wane following the third dose. Noninvasive measurements of neurological health parameters hold promise for developing and directing resuscitation strategies.

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Section: Discussionmentioning

confidence: 99%

Epinephrine’s effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

Mavroudis

Morgan

et al. 2020

Crit Care

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“…Despite its widespread use, a large body of experimental evidence from animal studies suggests that adrenaline may have no effect or even a detrimental effect on various measures of well-being and survival during resuscitation (Brown et al 1988;Wenzel et al 1999;Klouche et al 2003;Niemann and Garner 2005;Schwartz and Lagranha 2006) . High doses do not seem to improve survival and may increase adverse effects (Ditchey and Lindenfeld 1988;Lindner et al 1991b;Lindner et al 1991a;Hornchen et al 1993;Hilwig et al 2000;Voelckel et al 2000).…”

Section: Rationale For the Use Of Adrenaline In Cprmentioning

confidence: 99%

Vasopressors for cardiopulmonary resuscitation

Penson

Ford

Broadley

2007

Pharmacology & Therapeutics

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“…[40][41][42][43][44] The results from several animal resuscitation studies, as well as human adult case reports and preliminary studies, indicate that higher epinephrine doses than are currently recommended in ACLS guidelines may be required for cardiac resuscitation. 40,[44][45][46][47][48][49][50][51][52] Questions that need to be answered include whether all patients who experience cardiac arrest need higher epinephrine doses for resuscitation and, if such doses are instituted, whether they will be more beneficial than harmful when compared with standard doses.…”

Section: Epinephrine (Adrenalin)mentioning

confidence: 99%

Controversies in Cardiopulmonary Resuscitation: Pediatric Considerations

Thompson

Raebel²,

Sagraves

et al. 1991

DICP

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This articleaddresses some therapeutic controversies concerning medications that may be neededduringadvancedpediatric life support(APLS) and the routesof administration that may be selected. The controversies that are discussedincludethe appropriateness and selection of variousroutesfor drug administration during APLS; the determination of whetherepinephrine hydrochloride is the adrenergic agentof choicefor APLS and its appropriate dose; treatment of acidosis associated with a cardiopulmonary arrest;recommendations for atropine sulfatedoses;and the role,if any, of calciumin APLS. Background information differentiating pediatricfrom adultcardiopulmonary arrestis presented to enablethe readerto have a betterunderstanding of the specific needsof childrenduring this life-threatening emergency. The articlealso presentsan overview of variousdrugs used for APLS and a table of their typically recommended doses and routes of administration. Pharmacother 1991;25:760-72. CHILDREN WHO EXPERIENCE CARDIAC ARREST typically have a poor prognosis.v' Pediatric survival rates from cardiac arrests that occur in the prehospital setting average 7 percent (3 percent if arrests were unwitnessed and 15 percent if witnessed by paramedics).' Such figures are low when compared with an overall survival rate of 20 percent for adults who experienced cardiac arrests in a similar setting," From DICPAnn

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Effect of standard doses of epinephrine on myocardial oxygen delivery and utilization during cardiopulmonary resuscitation

Cited by 44 publications

References 0 publications

Epinephrine’s effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

Epinephrine’s effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

Vasopressors for cardiopulmonary resuscitation

Controversies in Cardiopulmonary Resuscitation: Pediatric Considerations

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