Plasma catecholamine concentrations after successful resuscitation in patients

Prengel, Andreas W.; Lindner, Karl H.; Ensinger, H.; Grünert, A.

doi:10.1097/00003246-199205000-00011

Cited by 80 publications

(35 citation statements)

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“…Although speculative, the success of the individualized approach may be that it allows rescuers to avert potential harm of overly deep compressions and/or vasopressor use when they are not required. By titrating CPR effect to blood pressure, compressions that were too deep for a given "patient" were avoided (38) and unnecessary vasopressors that could adversely affect myocardial afterload after ROSC (39)(40)(41)(42)(43) were avoided unless they were needed to maintain CPP during CPR.…”

Section: Discussionmentioning

confidence: 99%

Patient-Centric Blood Pressure–targeted Cardiopulmonary Resuscitation Improves Survival from Cardiac Arrest

Sutton

Friess

Naim

et al. 2014

Am J Respir Crit Care Med

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Rationale: Although current resuscitation guidelines are rescuer focused, the opportunity exists to develop patient-centered resuscitation strategies that optimize the hemodynamic response of the individual in the hopes to improve survival.Objectives: To determine if titrating cardiopulmonary resuscitation (CPR) to blood pressure would improve 24-hour survival compared with traditional CPR in a porcine model of asphyxia-associated ventricular fibrillation (VF).Methods: After 7 minutes of asphyxia, followed by VF, 20 female 3-month-old swine randomly received either blood pressure-targeted care consisting of titration of compression depth to a systolic blood pressure of 100 mm Hg and vasopressors to a coronary perfusion pressure greater than 20 mm Hg (BP care); or optimal American Heart Association Guideline care consisting of depth of 51 mm with standard advanced cardiac life support epinephrine dosing (Guideline care). All animals received manual CPR for 10 minutes before first shock. Primary outcome was 24-hour survival.Measurements and Main Results: The 24-hour survival was higher in the BP care group (8 of 10) compared with Guideline care (0 of 10); P = 0.001. Coronary perfusion pressure was higher in the BP care group (point estimate 18.5 mm Hg; 95% confidence interval, 3.9-13.0 mm Hg; P , 0.01); however, depth was higher in Guideline care (point estimate 19.3 mm; 95% confidence interval, 6.0-12.5 mm; P , 0.01). Number of vasopressor doses before first shock was higher in the BP care group versus Guideline care (median, 3 [range, 0-3] vs. 2 [range, 2-2]; P = 0.003).Conclusions: Blood pressure-targeted CPR improves 24-hour survival compared with optimal American Heart Association care in a porcine model of asphyxia-associated VF cardiac arrest.

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Section: Discussionmentioning

confidence: 99%

Patient-Centric Blood Pressure–targeted Cardiopulmonary Resuscitation Improves Survival from Cardiac Arrest

Sutton

Friess

Naim

et al. 2014

Am J Respir Crit Care Med

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“…Cardiac arrest and CPR stimulate the release of catecholamines [26] and neutrophil elastase [27]. Furthermore, massive doses of exogenous epinephrine are injected as an inotropic agent during CPR.…”

Section: Discussionmentioning

confidence: 99%

Platelet activation with massive formation of thromboxane A 2 during and after cardiopulmonary resuscitation

Gando¹,

Koyama²,

Nanzaki³

et al. 1997

Intensive Care Medicine

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“…It is important to recognize that normal or elevated heart rate and blood pressure immediately after ROSC can be caused by a transient increase in local and circulating catecholamine concentrations. 103,104 When post-cardiac arrest myocardial dysfunction occurs, it can be detected within minutes of ROSC by appropriate monitoring. In swine studies, the ejection fraction decreases from 55% to 20%, and left ventricular end-diastolic pressure increases from 8 to 10 mm Hg to 20 to 22 mm Hg as early as 30 minutes after ROSC.…”

Section: Post-cardiac Arrest Myocardial Dysfunctionmentioning

confidence: 99%