Variable effects of high-dose adrenaline relative to standard-dose adrenaline on resuscitation outcomes according to cardiac arrest duration.

Abstract

AIM OF THE STUDY:

Adjustment of adrenaline (epinephrine) dosage according to cardiac arrest (CA) duration, rather than administering the same dose, may theoretically improve resuscitation outcomes. We evaluated variable effects of high-dose adrenaline (HDA) relative to standard-dose adrenaline (SDA) on resuscitation outcomes according to CA duration.

METHODS:

Twenty-eight male domestic pigs were randomised to the following 4 groups according to the dosage of adrenaline (SDA 0.02 mg/kg vs. HDA 0.2mg/kg) and duration of CA before beginning cardiopulmonary resuscitation (CPR): 6 min SDA, 6 min HDA, 13 min SDA, or 13 min HDA. After the predetermined duration of untreated ventricular fibrillation, CPR was provided.

RESULTS:

All animals in the 6 min SDA, 6 min HDA, and 13 min HDA groups were successfully resuscitated, while only 4 of 7 pigs in the 13 min SDA group were successfully resuscitated (p=0.043). HDA groups showed higher right atrial pressure, more frequent ventricular ectopic beats, higher blood glucose, higher troponin-I, and more severe metabolic acidosis than SDA groups. Animals of 13 min groups showed more severe metabolic acidosis and higher troponin-I than animals of 6 min groups. All successfully resuscitated animals, except two animals in the 13 min HDA group, survived for 7 days (p=0.121). Neurologic deficit score was not affected by the dose of adrenaline.

CONCLUSION:

HDA showed benefit in achieving restoration of spontaneous circulation in 13 min CA, when compared with 6 min CA. However, this benefit did not translate into improved long-term survival or neurologic outcome.

• Authors: Kyung Woon Jeung, Hyun Ho Ryu, Kyung Hwan Song, Byung Kook Lee, Hyoung Youn Lee, Tag Heo, Yong Il Min
• Journal: Resuscitation (Resuscitation) Vol. 82 Issue 7 Pg. 932-6 (Jul 2011) ISSN: 1873-1570 [Electronic] Ireland
• PMID: 21482013 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Vasoconstrictor Agents
• Epinephrine

Topics

• Animals
• Cardiopulmonary Resuscitation (methods)
• Disease Models, Animal
• Dose-Response Relationship, Drug
• Epinephrine (administration & dosage)
• Follow-Up Studies
• Heart Arrest (physiopathology, therapy)
• Hemodynamics (drug effects)
• Male
• Recovery of Function (drug effects)
• Swine
• Time Factors
• Treatment Outcome
• Vasoconstrictor Agents (administration & dosage)