Journal article
Epinephrine's effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation
Critical care (London, England), Vol.24(1), pp.583-583
09/29/2020
DOI: 10.1186/s13054-020-03297-4
PMCID: PMC7522922
PMID: 32993753
Abstract
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.
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
]) 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.
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).
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.
Details
- Title: Subtitle
- Epinephrine's effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation
- Creators
- Constantine D Mavroudis - Division of Cardiovascular Surgery, The University of Pennsylvania, Philadelphia, PA, USA. mavroudisc@email.chop.eduTiffany S Ko - Department of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USARyan W Morgan - Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USALindsay E Volk - Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USAWilliam P Landis - Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USABenjamin Smood - Division of Cardiovascular Surgery, The University of Pennsylvania, Philadelphia, PA, USARui Xiao - Department of Pediatrics, Division of Biostatistics, Children's Hospital of Philadelphia, Philadelphia, PA, USAMarco Hefti - Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USATimothy W Boorady - Department of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USAAlexandra Marquez - Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USAMichael Karlsson - Department of Neurosurgery, Rigshospitalet, Copenhagen, DenmarkDaniel J Licht - Department of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USAVinay M Nadkarni - Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USARobert A Berg - Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USARobert M Sutton - Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USATodd J Kilbaugh - Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Resource Type
- Journal article
- Publication Details
- Critical care (London, England), Vol.24(1), pp.583-583
- DOI
- 10.1186/s13054-020-03297-4
- PMID
- 32993753
- PMCID
- PMC7522922
- NLM abbreviation
- Crit Care
- ISSN
- 1364-8535
- eISSN
- 1466-609X
- Publisher
- England
- Grant note
- T32 HL007915 / NHLBI NIH HHS R01HL141386 / NHLBI NIH HHS K23 HL148541 / NHLBI NIH HHS
- Language
- English
- Date published
- 09/29/2020
- Academic Unit
- Pathology; Iowa Neuroscience Institute
- Record Identifier
- 9984070798602771
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