title: Physiologic effect of repeated adrenaline (epinephrine) doses during cardiopulmonary resuscitation in the cath lab setting: A randomised porcine study.
abstract: BACKGROUND
  This porcine study was designed to explore the effects of repetitive intravenous adrenaline doses on physiologic parameters during CPR.
  
  
  METHODS
  Thirty-six adult pigs were randomised to four injections of: adrenaline 0.02 mg(kgdose)(-1), adrenaline 0.03 mg(kgdose)(-1) or saline control. The effect on systolic, diastolic and mean arterial blood pressure, cerebral perfusion pressure (CePP), end tidal carbon dioxide (ETCO2), arterial oxygen saturation via pulse oximetry (SpO2), cerebral tissue oximetry (SctO2), were analysed immediately prior to each injection and at peak arterial systolic pressure and arterial blood gases were analysed at baseline and after 15 min.
  
  
  RESULTS
  In the group given 0.02 mg(kgdose)(-1), there were increases in all arterial blood pressures at all 4 pressure peaks but CePP only increased significantly after peak 1. A decrease in ETCO2 following peak 1 and 2 was observed. SctO2 and SpO2 were lowered following injection 2 and beyond. In the group given a 0.03 mg(kgdose)(-1), all ABP's increased at the first 4 pressure peaks but CePP only following 3 pressure peaks. Lower ETCO2, SctO2 and SpO2 were seen at peak 1 and beyond. In the two adrenaline groups, pH and Base Excess were lower and lactate levels higher compared to baseline as well as compared to the control.
  
  
  CONCLUSIONS
  Repetitive intravenous adrenaline doses increased ABP's and to some extent also CePP, but significantly decreased organ and brain perfusion. The institutional protocol number: Malmö/Lund Committee for Animal Experiment Ethics, approval reference number: M 192-10.
authors.affiliation: Physio-Control/Jolife AB, Ideon Science Park, Lund, Sweden. Electronic address: bjarne.madsen.hardig@physio-control.com.
authors.forename: Bjarne Madsen
authors.initials: BM
authors.lastname: Hardig
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Götberg
authors.affiliation: Department of Anaesthesiology and Intensive Care, Lund University, Lund, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Rundgren
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden.
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Zughaft
authors.affiliation: CAS Medical Systems, Inc., Branford, CT 06405, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Kopotic
authors.affiliation: Department of Cardiology, Lund University, Lund, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Wagner
mesh_terms: D000818:Animals; D062186:Arterial Pressure / Q000187:drug effects; D002245:Carbon Dioxide / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage*; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D010100:Oxygen / Q000097:blood; D011897:Random Allocation; D013552:Swine
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen; D004837:Epinephrine
keywords: Adrenaline; CPR; Cardiac arrest