The role of epinephrine in CPR: A reappraisal

Otto, Charles W.; Yakaitis, Ronald W.

doi:10.1016/s0196-0644(84)80455-2

Cited by 80 publications

(28 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Evidence suggests that the important actions of EP for ROSC are mostly mediated by the α-adrenergic pathway, which increases coronary perfusion pressure via systemic arteriolar vasoconstriction, maintains peripheral vascular tone, and prevents arteriolar collapse [5]. In contrast to the α-adrenergic receptor effects, β-adrenergic receptor stimulation has been suggested to have a deleterious effect as stimulation of this pathway increases oxygen consumption, reduces sub-endocardial perfusion, and decreases post-resuscitation myocardial function [6].…”

Section: Introductionmentioning

confidence: 99%

Combination of Epinephrine with Esmolol Attenuates Post-Resuscitation Myocardial Dysfunction in a Porcine Model of Cardiac Arrest

Zhang

Liu

2013

PLoS ONE

View full text Add to dashboard Cite

BackgroundRecent experimental and clinical studies have indicated that the β-adrenergic effect of epinephrine significantly increases the severity of post resuscitation myocardial dysfunction. The aim of the study was to investigate whether the short-acting β1-selective adrenergic blocking agent, esmolol, would attenuate post resuscitation myocardial dysfunction in a porcine model of cardiac arrest.Methods and ResultsAfter 8 min of untreated ventricular fibrillation and 2 min of basic life support, 24 pigs were randomized to three groups (n = 8 per group), which received central venous injection of either epinephrine combined with esmolol (EE group), epinephrine (EP group), or saline (SA group). Hemodynamic status and blood samples were obtained at 0, 30, 60, 120, 240 and 360 min after return of spontaneous circulation (ROSC). Surviving pigs were euthanatized at 24 h after ROSC, and the hearts were removed for analysis by electron microscopy, Western blotting, quantitative real-time polymerase chain reaction, and terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling (TUNEL) assay. Compared with the EP and SA groups, EE group had a better outcome in hemodynamic function, (improved dp/dt maxima and minima and cardiac output) (P<0.05), and improved oxygen metabolism (oxygen delivery and oxygen consumption) (P<0.05), which suggesting that EE can protect myocardial tissue from injury and improve post-resuscitation myocardial dysfunction. The protective effect of EE also correlated with reducing cardiomyocyte apoptosis, evidenced by reducing TUNEL-positive cells, increasing anti-apoptotic Bcl-2/Bax ratio and suppression of caspase-3 activity in myocardium.ConclusionsEsmolol, a short-acting β1-selective adrenergic blocking agent, given during CPR has significant effects on attenuating post resuscitation myocardial dysfunction. The current study provides a potential pharmacologic target for post resuscitation myocardial dysfunction.

show abstract

Section: Introductionmentioning

confidence: 99%

Combination of Epinephrine with Esmolol Attenuates Post-Resuscitation Myocardial Dysfunction in a Porcine Model of Cardiac Arrest

Zhang

Liu

2013

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Epinephrine administered at low concentrations (e.g., 0.1 µg/kg) paradoxically can produce vasodilation because low dose epinephrine have greater sensitivity to vasodilator beta-2 receptors than vasoconstrictor alpha receptors,3)7) and beta-adrenergic stimulation leads to coronary vasodilatation 8-10). However, high dose epinephrine increases myocardial oxygen consumption, decrease myocardial ATP with prodysrhythmic effects such as ventricular fibrillation and myocardial lactate level 4)6)7). Because there were some limitations regarding dose-dependent effects of epinephrine, we had to use epinephrine carefully.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Intracoronary Epinephrine in Severe Hypotension during Percutaneous Coronary Interventions

et al. 2013

View full text Add to dashboard Cite

Background and ObjectivesLife-threatening hypotension during percutaneous coronary interventions (PCI) is devastating for the patient and is associated with fatal adverse outcomes. The aim of our study was to assess the usefulness of intracoronary epinephrine in severe hypotension unresponsive to other measures during PCI.Subjects and MethodsWe analyzed the Pusan National University Yangsan hospital cardiac catheterization laboratory database to identify patients who underwent PCI from December 2008 to July 2012. The outcomes were changes of blood pressure (BP) and heart rate (HR) before and after intracoronary epinephrine and in-hospital mortality.ResultsA total of 30 patients who were initially stable and received intracoronary epinephrine for severe hypotension during PCI were included. Following administration of intracoronary epinephrine (dose 181±24.8 microgram), systolic and diastolic BP (from 53.8±13.0 mm Hg up to 112.8±21.2 mm Hg, from 35±7.6 mm Hg up to 70.6±12.7 mm Hg, respectively) and HR (from 39.4±5.1 beats/min up to 96.8±29.3 beats/min) were increased. Additionally, 21 patients (70%) showed hemodynamically acceptable responses to intracoronary epinephrine without the intraaortic balloon pump and temporary pacemaker during the PCI. In-hospital mortality was 17% (n=5).ConclusionAlthough our study was small, intracoronary epinephrine was found to be well tolerated and resulted in prompt and successful recovery from severe hypotension in most patients when other measures were ineffective. Intracoronary epinephrine could be a safe and useful measure in patients developing severe hypotension during PCI.

show abstract

“…On the other hand, these factors were important in maintaining adequate CPP during CPR [1, 19,20]. Therefore, it may be recommended to avoid an inadequately high dose of epinephrine or the combined use of some drugs to prevent pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

Landiolol, an ultra short acting β1-blocker, improves pulmonary edema after cardiopulmonary resuscitation with epinephrine in rats

et al. 2009

View full text Add to dashboard Cite

show abstract

The role of epinephrine in CPR: A reappraisal

Cited by 80 publications

References 12 publications

Combination of Epinephrine with Esmolol Attenuates Post-Resuscitation Myocardial Dysfunction in a Porcine Model of Cardiac Arrest

Combination of Epinephrine with Esmolol Attenuates Post-Resuscitation Myocardial Dysfunction in a Porcine Model of Cardiac Arrest

Usefulness of Intracoronary Epinephrine in Severe Hypotension during Percutaneous Coronary Interventions

Landiolol, an ultra short acting β1-blocker, improves pulmonary edema after cardiopulmonary resuscitation with epinephrine in rats

Contact Info

Product

Resources

About