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Cerebral effects of resuscitation with either epinephrine or vasopressin in an animal model of hemorrhagic shock

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Abstract

Purpose

The use of epinephrine (EN) or vasopressin (VP) in hemorrhagic shock is well established. Due to its specific neurovascular effects, VP might be superior in concern to brain tissue integrity. The aim of this study was to evaluate cerebral effects of either EN or VP resuscitation after hemorrhagic shock.

Methods

After shock induction fourteen pigs were randomly assigned to two treatment groups. After 60 min of shock, resuscitation with either EN or VP was performed. Hemodynamics, arterial blood gases as well as cerebral perfusion pressure (CPP) and brain tissue oxygenation (PtiO2) were recorded. Interstitial lactate, pyruvate, glycerol and glutamate were assessed by cerebral and subcutaneous microdialysis. Treatment-related effects were compared using one-way ANOVA with post hoc Bonferroni adjustment (p < 0.05) for repeated measures.

Results

Induction of hemorrhagic shock led to a significant (p < 0.05) decrease of mean arterial pressure (MAP), cardiac output (CO) and CPP. Administration of both VP and EN sufficiently restored MAP and CPP and maintained physiological PtiO2 levels. Brain tissue metabolism was not altered significantly during shock and subsequent treatment with VP or EN. Concerning the excess of glycerol and glutamate, we found a significant EN-related release in the subcutaneous tissue, while brain tissue values remained stable during EN treatment. VP treatment resulted in a non-significant increase of cerebral glycerol and glutamate.

Conclusions

Both vasopressors were effective in restoring hemodynamics and CPP and in maintaining brain oxygenation. With regards to the cerebral metabolism, we cannot support beneficial effects of VP in this model of hemorrhagic shock.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Jan Küchler, Emma Smith, Jan Gliemroth & Claudia Ditz

  2. Department of Anesthesiology, Herz-Jesu-Krankenhaus Münster-Hiltrup, Münster, Germany

    Stephan Klaus

  3. Department of Anesthesiology, Klinikum Weser Egge, Höxter, Germany

    Ludger Bahlmann

  4. Department of Pediatrics, Klinikum Bremen-Mitte, Bremen, Germany

    Nils Onken

  5. Department of Gynecology and Obstetrics, Klinikum Osnabrück, Osnabrück, Germany

    Alexander Keck

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  1. Jan Küchler
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Correspondence to Claudia Ditz.

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Ethical approval

This animal study has been approved by the institutional ethics committee. All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

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Küchler, J., Klaus, S., Bahlmann, L. et al. Cerebral effects of resuscitation with either epinephrine or vasopressin in an animal model of hemorrhagic shock. Eur J Trauma Emerg Surg 46, 1451–1461 (2020). https://doi.org/10.1007/s00068-019-01158-6

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  • DOI: https://doi.org/10.1007/s00068-019-01158-6

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