title: Effects of epinephrine on cerebral oxygenation during cardiopulmonary resuscitation: A prospective cohort study.
abstract: Epinephrine has been presumed to improve cerebral oxygen delivery during cardiopulmonary resuscitation (CPR), but animal and registry studies suggest that epinephrine-induced capillary vasoconstriction may decrease cerebral capillary blood flow and worsen neurological outcome. The effect of epinephrine on cerebral oxygenation (rSO2) during CPR has not been documented in the clinical setting.
  
  
  
  rSO2was measured continuously using cerebral oximetry in patients with in-hospital cardiac arrest. During CPR, time event markers recorded the administration of 1mg epinephrine. rSO2values were analysed for a period beginning 5min before and ending 5min after the first epinephrine administration.
  
  
  
  A total of 56 epinephrine doses were analysed in 36 patients during CPR. The average rSO2value in the 5-min following epinephrine administration was 1.40% higher (95% CI=0.41-2.40%; P=0.0059) than in the 5-min period before epinephrine administration. However, there was no difference in the overall rate of change of rSO2when comparing the 5-min period before, with the 5-min period immediately after a single bolus dose of epinephrine (0.88%/min vs 1.07%/min respectively; P=0.583), There was also no difference in the changes in rSO2at individual 1, 2, 3, or 4-min time windows before and after a bolus dose of epinephrine (P=0.5827, 0.2371, 0.2082, and 0.6707 respectively).
  
  
  
  A bolus of 1mg epinephrine IV during CPR produced a small but clinically insignificant increase in rSO2in the five minutes after administration. This is the first clinical data to demonstrate the effects of epinephrine on cerebral rSO2during CPR.
authors: NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, UK.
authors: Charles D
authors: CD
authors: Deakin
authors: State University of New York at Stony Brook, School of Medicine, Stony Brook, NY, USA.
authors: Jie
authors: J
authors: Yang
authors: State University of New York at Stony Brook, School of Medicine, Stony Brook, NY, USA.
authors: Robert
authors: R
authors: Nguyen
authors: State University of New York at Stony Brook, School of Medicine, Stony Brook, NY, USA.
authors: Jiawen
authors: J
authors: Zhu
authors: Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, London, UK.
authors: Stephen J
authors: SJ
authors: Brett
authors: University of Bristol, Royal United Hospital, Bath, UK.
authors: Jerry P
authors: JP
authors: Nolan
authors: University of Warwick and Heart of England NHS Foundation Trust, Coventry, UK.
authors: Gavin D
authors: GD
authors: Perkins
authors: University of Portsmouth, Portsmouth, UK.
authors: David G
authors: DG
authors: Pogson
authors: State University of New York at Stony Brook, School of Medicine, Stony Brook, NY, USA.
authors: Sam
authors: S
authors: Parnia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010101:Oxygen Consumption / Q000187:drug effects*; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine
keywords: Cerebral blood flow; Epinephrine; Resuscitation