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Open Access 01-12-2014 | Research article

Repeated epinephrine doses during prolonged cardiopulmonary resuscitation have limited effects on myocardial blood flow: a randomized porcine study

Authors: Henrik Wagner, Michael Götberg, Bjarne Madsen Hardig, Malin Rundgren, Jonas Carlson, Matthias Götberg, David Zughaft, David Erlinge, Göran K Olivecrona

Published in: BMC Cardiovascular Disorders | Issue 1/2014

Abstract

Background

In current guidelines, prolonged cardiopulmonary resuscitation (CPR) mandates administration of repeated intravenous epinephrine (EPI) doses. This porcine study simulating a prolonged CPR-situation in the coronary catheterisation laboratory, explores the effect of EPI-administrations on coronary perfusion pressure (CPP), continuous coronary artery flow average peak velocity (APV) and amplitude spectrum area (AMSA).

Methods

Thirty-six pigs were randomized 1:1:1 to EPI 0.02 mg/kg/dose, EPI 0.03 mg/kg/dose or saline (control) in an experimental cardiac arrest (CA) model. During 15 minutes of mechanical chest compressions, four EPI/saline-injections were administered, and the effect on CPP, APV and AMSA were recorded. Comparisons were performed between the control and the two EPI-groups and a combination of the two EPI-groups, EPI-all.

Result

Compared to the control group, maximum peak of CPP (P_max) after injection 1 and 2 was significantly increased in the EPI-all group (p = 0.022, p = 0.016), in EPI 0.02-group after injection 2 and 3 (p = 0.023, p = 0.027) and in EPI 0.03-group after injection 1 (p = 0.013). At P_max, APV increased only after first injection in both the EPI-all and the EPI 0.03-group compared with the control group (p = 0.011, p = 0.018). There was no statistical difference of AMSA at any P_max. Seven out of 12 animals (58%) in each EPI-group versus 10 out of 12 (83%) achieved spontaneous circulation after CA.

Conclusion

In an experimental CA-CPR pig model repeated doses of intravenous EPI results in a significant increase in APV only after the first injection despite increments in CPP also during the following 2 injections indicating inappropriate changes in coronary vascular resistance during subsequent EPI administration.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2261/14/199/prepub

Title: Repeated epinephrine doses during prolonged cardiopulmonary resuscitation have limited effects on myocardial blood flow: a randomized porcine study
Authors: Henrik Wagner
Michael Götberg
Bjarne Madsen Hardig
Malin Rundgren
Jonas Carlson
Matthias Götberg
David Zughaft
David Erlinge
Göran K Olivecrona
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2014
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/1471-2261-14-199

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Repeated epinephrine doses during prolonged cardiopulmonary resuscitation have limited effects on myocardial blood flow: a randomized porcine study

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Result

Conclusion

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