Epinephrine’s effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

Critical Care

Alexandra Marquez¹  Vinay M. Nadkarni¹  Ryan W. Morgan¹  William P. Landis¹  Robert M. Sutton¹  Robert A. Berg¹  Todd J. Kilbaugh¹  Tiffany S. Ko²  Daniel J. Licht²  Timothy W. Boorady²  Michael Karlsson³  Marco Hefti⁴  Rui Xiao⁵  Lindsay E. Volk⁶  Constantine D. Mavroudis⁷  Benjamin Smood⁸ 

[1] Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA;Department of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA;Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark;Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA;Department of Pediatrics, Division of Biostatistics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA;Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, 19104, Philadelphia, PA, USA;Division of Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, 19104, Philadelphia, PA, USA;Division of Cardiovascular Surgery, The University of Pennsylvania, Philadelphia, PA, USA;Division of Cardiovascular Surgery, The University of Pennsylvania, Philadelphia, PA, USA;

关键词: Cardiopulmonary resuscitation;    Cerebral blood flow;    Cerebral blood flow and metabolism;    Diffuse correlation spectroscopy;    Diffuse optical spectroscopy;   

DOI  :  10.1186/s13054-020-03297-4

来源: Springer

【 摘 要 】

BackgroundDespite 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.MethodsOne-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 [PbtO2]) 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.ResultsWith 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).ConclusionsThis 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.

【 授权许可】

CC BY