Epinephrine's effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation.

Autor: Mavroudis CD; Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. mavroudisc@email.chop.edu.; Division of Cardiovascular Surgery, The University of Pennsylvania, Philadelphia, PA, USA. mavroudisc@email.chop.edu., Ko TS; Department of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Morgan RW; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Volk LE; Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA., Landis WP; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Smood B; Division of Cardiovascular Surgery, The University of Pennsylvania, Philadelphia, PA, USA., Xiao R; Department of Pediatrics, Division of Biostatistics, Children's Hospital of Philadelphia, Philadelphia, PA, USA., Hefti M; Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA., Boorady TW; Department of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Marquez A; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Karlsson M; Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark., Licht DJ; Department of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Nadkarni VM; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Berg RA; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Sutton RM; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA., Kilbaugh TJ; Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2020 Sep 29; Vol. 24 (1), pp. 583. Date of Electronic Publication: 2020 Sep 29.
DOI: 10.1186/s13054-020-03297-4
Abstrakt: Background: Despite controversies, epinephrine remains a mainstay of cardiopulmonary resuscitation (CPR). Recent animal studies have suggested that epinephrine may decrease cerebral blood flow (CBF) and cerebral oxygenation, possibly potentiating neurological injury during CPR. We investigated the cerebrovascular effects of intravenous epinephrine in a swine model of pediatric in-hospital cardiac arrest. The primary objectives of this study were to determine if (1) epinephrine doses have a significant acute effect on CBF and cerebral tissue oxygenation during CPR and (2) if the effect of each subsequent dose of epinephrine differs significantly from that of the first.
Methods: One-month-old piglets (n = 20) underwent asphyxia for 7 min, ventricular fibrillation, and CPR for 10-20 min. Epinephrine (20 mcg/kg) was administered at 2, 6, 10, 14, and 18 min of CPR. Invasive (laser Doppler, brain tissue oxygen tension [PbtO 2 ]) and noninvasive (diffuse correlation spectroscopy and diffuse optical spectroscopy) measurements of CBF and cerebral tissue oxygenation were simultaneously recorded. Effects of subsequent epinephrine doses were compared to the first.
Results: With the first epinephrine dose during CPR, CBF and cerebral tissue oxygenation increased by > 10%, as measured by each of the invasive and noninvasive measures (p < 0.001). The effects of epinephrine on CBF and cerebral tissue oxygenation decreased with subsequent doses. By the fifth dose of epinephrine, there were no demonstrable increases in CBF of cerebral tissue oxygenation. Invasive and noninvasive CBF measurements were highly correlated during asphyxia (slope effect 1.3, p < 0.001) and CPR (slope effect 0.20, p < 0.001).
Conclusions: This model suggests that epinephrine increases CBF and cerebral tissue oxygenation, but that effects wane following the third dose. Noninvasive measurements of neurological health parameters hold promise for developing and directing resuscitation strategies.
Databáze: MEDLINE
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