Optimizing myocardial supply/demand balance with α-adrenergic drugs during cardiopulmonary resuscitation

Livesay, James J.; Follette, David M.; Fey, K.; Nelson, Ronald J.; DeLand, Edward Charles; Barnard, R. James; Buckberg, Gerald D.

doi:10.1016/s0022-5223(19)41146-x

Cited by 149 publications

(18 citation statements)

References 27 publications

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“…The lack of beneficial effects in clinical studies may have several possible explanations. First, adrenaline has β‐adrenergic effects, which may be detrimental by causing increased myocardial oxygen consumption during ventricular fibrillation (7) and myocardial dysfunction in the postresuscitation phase (8). Second, several different doses of adrenaline have been evaluated during CPR, but the optimal dose is still a matter of controversy (9).…”

mentioning

confidence: 99%

Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines

Johansson

Hammerby²,

Oldgren

et al. 2004

Acta Anaesthesiol Scand

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mentioning

confidence: 99%

Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines

Johansson

Hammerby²,

Oldgren

et al. 2004

Acta Anaesthesiol Scand

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“…Livesay et al . [29] demonstrated that the β 1 ‐effects of epinephrine augment the vigour of fibrillation, increasing myocardial oxygen demand and intraventricular pressures, which decrease subendocardial perfusion. β 2 ‐stimulation appears to preferentially dilate larger coronary vessels, potentially diverting blood away from the subendocardium, which further jeopardises perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…[47] and Livesay et al . [29] have shown that aortic diastolic pressure was a prognostic indicator of survival in dogs. Paradis et al .…”

Section: Discussionmentioning

confidence: 99%

Use of alpha‐agonists for management of anaphylaxis occurring under anaesthesia: case studies and review

Heytman

Rainbird

2004

Anaesthesia

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SummaryAnaphylaxis is an uncommon but serious complication of anaesthesia. Most current guidelines for the management of anaphylaxis list only epinephrine as a vasopressor to use in the event of cardiovascular collapse. We present two cases of anaphylaxis under anaesthesia where return of spontaneous circulation was refractory to epinephrine, but occurred following the administration of the alpha-agonist metaraminol. Potential advantages and disadvantages of using epinephrine in this setting, the role of alpha-agonists and some potential mechanisms accounting for their role in successful management are reviewed.

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“…This diastolic augmentation provided by IAC-CPR appears to be similar to that of intraaortic balloon counterpulsation. Unlike epinephrine administration, however, IAC improves coronary perfusion pressure without increasing myocardial oxygen consumption (MVO 2 ) 36 . Alternatively, the use of interposed abdominal compression to supplement exogenous catecholamines during cardiac arrest could improve myocardial oxygen supply sufficiently to negate or cancel epinephrine-induced increases in myocardial oxygen demand.…”

Section: Hemodynamic Mechanisms Of Iac-cprmentioning

confidence: 99%

Interposed abdominal compression as an adjunct to cardiopulmonary resuscitation

Babbs

Sack

Kern

1994

American Heart Journal

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The addition of interposed abdominal compression (IAC) to otherwise standard CPR provides external pressure over the abdomen in counterpoint to the rhythm of chest compression. Interposed abdominal compression is a simple manual technique that can supplement the use of adrenergic drugs to increase both coronary perfusion pressure and total blood flow during CPR. Mechanistically, manual abdominal compressions induce both central aortic and central venous pressure pulses. However, owing to differences in venous versus arterial capacitance, the former are usually greater than the latter, so that systemic perfusion pressure is enhanced. Moreover, practical experience and theoretical analysis have suggested subtle refinements in the hand position and technique for abdominal compression that may further improve the ratio of arterial to venous pressure augmentation. Clinical studies confirm that IAC-CPR can improve perfusion pressures and carbon dioxide excretion during CPR in humans. The incidence of abdominal trauma, regurgitation, or other complications is not increased by IAC. Randomized trials have shown that short-term and long-term survival of patients resuscitated in the hospital by IAC-CPR are about twice that of control patients resuscitated by standard CPR. The technique of IAC has thus evolved to become a highly promising adjunct to normal CPR, which is likely to be implemented in an increasing number of clinical protocols.

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Optimizing myocardial supply/demand balance with α-adrenergic drugs during cardiopulmonary resuscitation

Cited by 149 publications

References 27 publications

Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines

Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines

Use of alpha‐agonists for management of anaphylaxis occurring under anaesthesia: case studies and review

Interposed abdominal compression as an adjunct to cardiopulmonary resuscitation

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