title: Intra-aortic administration of epinephrine above aortic occlusion does not alter outcome of experimental cardiopulmonary resuscitation.
abstract: Intra-aortic balloon occlusion during experimental cardiopulmonary resuscitation (CPR) improves coronary perfusion pressure and resuscitability and provides unique access to the central circulation. It has been hypothesized that administration of epinephrine into the aortic arch in combination with aortic occlusion would further improve haemodynamics during CPR, resuscitability and 24 h survival. In 16 anaesthetised dogs intravascular catheters were placed for hemodynamic and blood gas monitoring. An aortic balloon catheter was placed by femoral artery insertion with its tip just distal to the left subclavian artery. Ventricular fibrillation for 7.5 min without CPR, 2.5 min of Basic Life Support with chest compressions and ventilation with 100% oxygen were followed by 30 min of Advanced Cardiac Life Support (ACLS) with systemic canine drug dosages. The intra-aortic balloon was inflated when ACLS started and gradually deflated shortly after restoration of spontaneous circulation (ROSC). Epinephrine, in 100 microg/kg boluses every 5 min until the heart was restarted or 30 min had elapsed was administered through the intra-aortic catheter in the experimental group (n = 8) and via a central venous catheter in the control group (n = 8). Coronary perfusion pressure increased during the ACLS period in both groups (P < 0.05) with no difference between the groups and there was no difference in the frequency of ROSC (experimental group 5/8, control group 4/8). Furthermore with respect to 24 h survival, there was no difference between the experimental group (2/8) and the control group (3/8). Severe macroscopic haemorrhagic necrosis of the myocardium in the dogs with ROSC was found in 4/5 in the experimental group compared to 1/4 in the control group. In conclusion, intra-aortic administration of 100 microg/kg epinephrine doses combined with aortic occlusion during experimental CPR did not alter outcome.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine and Safar Center for Resuscitation Research, University of Pittsburgh, PA, USA. sten.rubertsson@anestesi.uu.se
authors.forename: S
authors.initials: S
authors.lastname: Rubertsson
authors.forename: N G
authors.initials: NG
authors.lastname: Bircher
authors.forename: S D
authors.initials: SD
authors.lastname: Smarik
authors.forename: M C
authors.initials: MC
authors.lastname: Young
authors.forename: H
authors.initials: H
authors.lastname: Alexander
authors.forename: A
authors.initials: A
authors.lastname: Grenvik
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D002404:Catheterization; D004195:Disease Models, Animal; D004285:Dogs; D004837:Epinephrine / Q000008:administration & dosage*; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D007261:Infusions, Intra-Arterial; D008297:Male; D012016:Reference Values; D015996:Survival Rate; D013566:Sympathomimetics / Q000008:administration & dosage*; D014693:Ventricular Fibrillation
chemical_list: D013566:Sympathomimetics; D004837:Epinephrine