Haemodynamic effects of adrenaline (epinephrine) depend on chest compression quality during cardiopulmonary resuscitation in pigs.
BACKGROUND
Adrenaline (epinephrine) is used during cardiopulmonary resuscitation (CPR) based on animal experiments without supportive clinical data. Clinically CPR was reported recently to have much poorer quality than expected from international guidelines and what is generally done in laboratory experiments. We have studied the haemodynamic effects of adrenaline during CPR with good laboratory quality and with quality simulating clinical findings and the feasibility of monitoring these effects through VF waveform analysis.


RESULTS
After 4 min of cardiac arrest, followed by 4 min of basic life support, 14 pigs were randomised to ClinicalCPR (intermittent manual chest compressions, compression-to-ventilation ratio 15:2, compression depth 30-38 mm) or LabCPR (continuous mechanical chest compressions, 12 ventilations/min, compression depth 45 mm). Adrenaline 0.02 mg/kg was administered 30 s thereafter. Plasma adrenaline concentration peaked earlier with LabCPR than with ClinicalCPR, median (range), 90 (30, 150) versus 150 (90, 270) s (p = 0.007), respectively. Coronary perfusion pressure (CPP) and cortical cerebral blood flow (CCBF) increased and femoral blood flow (FBF) decreased after adrenaline during LabCPR (mean differences (95% CI) CPP 17 (6, 29) mmHg (p = 0.01), FBF -5.0 (-8.8, -1.2) ml min(-1) (p = 0.02) and median difference CCBF 12% of baseline (p = 0.04)). There were no significant effects during ClinicalCPR (mean differences (95% CI) CPP 4.7 (-3.2, 13) mmHg (p = 0.2), FBF -0.2 (-4.6, 4.2) ml min(-1)(p = 0.9) and CCBF 3.6 (-1.8, 9.0)% of baseline (p = 0.15)). Slope VF waveform analysis reflected changes in CPP.


CONCLUSIONS
Adrenaline improved haemodynamics during laboratory quality CPR in pigs, but not with quality simulating clinically reported CPR performance.
Pytte
Morten
M
Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway. morten@pytte.no
Kramer-Johansen
Jo
J
Eilevstjønn
Joar
J
Eriksen
Morten
M
Strømme
Taevje A
TA
Godang
Kristin
K
Wik
Lars
L
Steen
Petter Andreas
PA
Sunde
Kjetil
K
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000592:standards; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003326:Coronary Circulation / Q000187:drug effects; D004562:Electrocardiography; D004837:Epinephrine / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use; D005263:Femoral Artery / Q000187:drug effects; D006323:Heart Arrest / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D006336:Heart Massage / Q000379:methods* / Q000592:standards; D011897:Random Allocation; D012039:Regional Blood Flow / Q000187:drug effects; D034421:Sus scrofa; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000493:pharmacokinetics / Q000494:pharmacology* / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D004837:Epinephrine