title: Endothelin-1 vasoconstriction during swine cardiopulmonary resuscitation improves coronary perfusion pressures but worsens postresuscitation outcome.
abstract: BACKGROUND
  Vasoconstriction during cardiopulmonary resuscitation (CPR) improves coronary perfusion pressure (CPP) and thereby outcome. The combination of endothelin-1 (ET-1) plus epinephrine improved CPP during CPR compared with epinephrine alone in a canine cardiac arrest model. The effect of the combination on outcome variables, such as successful resuscitation and survival, has not been investigated.
  
  
  RESULTS
  Twenty-seven swine were randomly provided with 1 mg epinephrine (Epi group) or 1 mg epinephrine plus 0.1 mg ET-1 (ET-1 group) during a prolonged ventricular fibrillatory cardiac arrest. ET-1 resulted in substantially superior aortic relaxation pressure and CPP during CPR. These hemodynamic improvements tended to increase initial rates of restoration of spontaneous circulation (8 of 10 versus 8 of 17, P=0.12). However, continued intense vasoconstriction from ET-1 led to higher aortic diastolic pressure and very narrow pulse pressure after resuscitation. The mean pulse pressure 1 hour after resuscitation was 7+/-8 mm Hg with ET-1 versus 24+/-1 mm Hg with Epi, P<0.01. Most importantly, the postresuscitation mortality was dramatically higher in the ET-1 group (6 of 8 versus 0 of 8 in the Epi group, P<0.01).
  
  
  CONCLUSIONS
  These data establish that administration of ET-1 during CPR can result in worse postresuscitation outcome. The intense vasoconstriction from ET-1 improved CPP during CPR but had detrimental effects in the postresuscitation period.
authors.affiliation: University of Arizona Department of Medicine, Tucson, AZ, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Hilwig
authors.forename: R A
authors.initials: RA
authors.lastname: Berg
authors.forename: K B
authors.initials: KB
authors.lastname: Kern
authors.forename: G A
authors.initials: GA
authors.lastname: Ewy
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D019332:Endothelin-1 / Q000494:pharmacology / Q000627:therapeutic use*; D004837:Epinephrine / Q000494:pharmacology / Q000627:therapeutic use*; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000187:drug effects; D013552:Swine; D017211:Treatment Failure; D014662:Vasoconstrictor Agents / Q000494:pharmacology / Q000627:therapeutic use*; D014693:Ventricular Fibrillation / Q000150:complications
chemical_list: D019332:Endothelin-1; D014662:Vasoconstrictor Agents; D004837:Epinephrine