title: Nitroglycerin and epinephrine improve coronary perfusion pressure in a porcine model of ventricular fibrillation arrest: a pilot study.
abstract: BACKGROUND
  Cardiac arrest remains one of the leading causes of death worldwide. European Resuscitation Council Guidelines for Resuscitation 2005 recommend epinephrine for its treatment.
  
  
  OBJECTIVE
  To estimate whether the administration of a vasodilatator such as nitroglycerin in combination with epinephrine during cardiopulmonary resuscitation would improve resuscitation outcome in an established model of ventricular fibrillation.
  
  
  METHODS
  
  
  
  METHODS
  Prospective, randomized, blinded, controlled study.
  
  
  METHODS
  Animal research laboratory. Ventricular fibrillation was induced in 20 Landrace/Large-White pigs. It remained untreated for 8 min before attempting resuscitation precordial compressions, mechanical ventilation, and electrical defibrillation. Animals were randomized into two groups, 10 animals each. Group A received saline as placebo (10 mL dilution, bolus) and epinephrine (0.02 mg/kg). Group B received nitroglycerin (50 microg/kg) and epinephrine (0.02 mg/kg) during cardiopulmonary resuscitation. Electrical defibrillation was attempted after 10 min of ventricular fibrillation.
  
  
  RESULTS
  Four animals in group A restored spontaneous circulation in comparison to eight in Group B. Coronary perfusion pressure (p < 0.0001) was significantly increased in Group B during cardiopulmonary resuscitation.
  
  
  CONCLUSIONS
  A vasodilatator, when administered in combination with a vasopressor such as epinephrine during cardiopulmonary resuscitation, increases coronary perfusion pressure.
authors.affiliation: Department of Experimental Surgery and Surgical Research, Medical School, University of Athens, Athens 11527, Greece.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Kitsou
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xanthos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stroumpoulis
authors.forename: George
authors.initials: G
authors.lastname: Rokas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Papadimitriou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Serpetinis
authors.forename: Ismene
authors.initials: I
authors.lastname: Dontas
authors.forename: Despina
authors.initials: D
authors.lastname: Perrea
authors.forename: Evangelia
authors.initials: E
authors.lastname: Kouskouni
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000188:drug therapy*; D007275:Injections, Intravenous; D008297:Male; D015425:Myocardial Reperfusion / Q000379:methods*; D005996:Nitroglycerin / Q000008:administration & dosage*; D034421:Sus scrofa; D013566:Sympathomimetics / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage*; D014693:Ventricular Fibrillation / Q000150:complications / Q000188:drug therapy*
chemical_list: D013566:Sympathomimetics; D014665:Vasodilator Agents; D005996:Nitroglycerin; D004837:Epinephrine