[Study on the value of the formula of rapid synchronous stepwise increase in dosage of epinephrine combined with aminophylline (7 mg/kg) in cardiopulmonary resuscitation].
OBJECTIVE
To investigate the effect of application and clinical value of use of epinephrine in graduate increased dosage according to the equation G=(K+2n-1)mg/3 minutes (K=1,2,n=1,2...5,G< or =0.2 mg/kg) combined with aminophylline in cardiopulmonary resuscitation (CPR).


METHODS
Three hundred and seventy-six patients with sudden cardiac arrest(CA) were randomly divided into 3 groups. Epinephrine and aminophylline were given through cubital vein with following methods: (1)CONTROL: (n=130). 1 mg of adrenaline was given as the first treatment. Repeat the same every 3 minutes if there was no effect. (2) In one hundred and thirty cases, the first dose of epinephrine was K=1 mg (n=122), K=2 mg (n=124). In K=1 mg group,epinephrine 1 mg and aminophylline 7 mg/kg were given as the first dose. If it was not effective, increasing dosage of epinephrine in order of 2, 3...17 mg and aminopyrine 7 mg/kg was given intravenously successively every 3 minutes (K=1, 2, n=1, 2...5). In group 2 (group equation 2), epinephrine 2 mg and aminophylline 7 mg/kg were given rapidly intravenously. If not effective, the drugs were repeated according to the equation intravenously every 3 minutes. When the dose of epinephrine exceeded 0.2 mg/kg, it should be stopped. Electrocardiogram, mean arterial pressure (MAP), the heart rate (HR), and the time of recovery of spontaneous circulation (+ROSC) were monitored, and they were evaluated for the effectiveness of resuscitation.


RESULTS
(1)+ROSC rate (91.13%, 88.52%), the 24-hour survival rate (85.48%, 67.21%), the survival rate (49.19%, 31.15%), and the Glasgow coma scores [(13.12+/-1.27)scores, (12.28+/-1.32) scores] were all significantly elevated in groups in which patients received the modified regime compared with the control group [26.92%, 25.39%, 12.31% and (9.08+/-1.13) scores, all P<0.01]. The average time for +ROSC in the equation 2 and 1 groups was (8.93+/-3.27) minutes and (8.25+/-5.25) minutes, respectively, and they were significantly shorter than those of the control group [(39.25+/-9.75) minutes, both P<0.01]. (2) The average dose of the epinephrine was much reduced in achieving +ROSC in two groups with modified regimes as compared with control group [(11.75+/-3.25) mg and (13.85+/-5.15) mg, respectively vs. (24.65+/-4.35) mg, both P<0.05], and the number of using application epinephrine via intravenous from the CPR initial stage to +ROSC in the equation 2 and 1 groups was much significantly decreased compared with the control group [(3.45+/-0.55) times and (3.85+/-0.75) times vs. (18.25+/-0.75) times, both P<0.01].


CONCLUSIONS
The newly formed regime has better effects in increasing significantly the success rate of cardiac-resuscitation, the survival rate, and it also shortens the time for successful recovery of spontaneous circulation. It can improve the recovery of brain and nervous system function.
Shi
Qi-biao
QB
Emergency Centre of Hu Xi Affiliated Hospital of Jining Medical College, Shanxian 274300, Shandong, China.
Zhang
Fu-xiang
FX
Wang
Gui-e
GE
Jiang
Feng-zhen
FZ
Xu
You-suo
YS
Huang
Xia
X
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000628:Aminophylline / Q000008:administration & dosage* / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D055815:Young Adult
D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D000628:Aminophylline; D004837:Epinephrine