Effects of epinephrine on cerebral oxygenation during cardiopulmonary resuscitation: A prospective cohort study

RESUSCITATION

卷:109

Article

Deakin, Charles D.¹  Yang, Jie²  Nguyen, Robert²  Zhu, Jiawen²  Brett, Stephen J.³  Nolan, Jerry P.⁴  Perkins, Gavin D.^5,6  Pogson, David G.⁷  Parnia, Sam² 

[1] Southampton Univ Hosp, NIHR Southampton Resp Biomed Res Unit, Southampton, Hants, England

[2] SUNY Stony Brook, Sch Med, Stony Brook, NY 11794 USA

[3] Imperial Coll Healthcare NHS Trust, Ctr Perioperat Med & Crit Care Res, London, England

[4] Univ Bristol, Royal United Hosp, Bath, Avon, England

[5] Univ Warwick, Coventry, W Midlands, England

[6] Heart England NHS Fdn Trust, Coventry, W Midlands, England

[7] Univ Portsmouth, Portsmouth, Hants, England

关键词: Resuscitation;    Epinephrine;    Cerebral blood flow;   

DOI  :  10.1016/j.resuscitation.2016.08.027

来源: Elsevier

【 摘 要 】

Background: Epinephrine has been presumed to improve cerebral oxygen delivery during cardiopulmonary resuscitation (CPR), but animal and registry studies suggest that epinephrine-induced capillary vasoconstriction may decrease cerebral capillary blood flow and worsen neurological outcome. The effect of epinephrine on cerebral oxygenation (rSO(2)) during CPR has not been documented in the clinical setting. Methods: rSO(2) was measured continuously using cerebral oximetry in patients with in-hospital cardiac arrest. During CPR, time event markers recorded the administration of 1 mg epinephrine. rSO(2) values were analysed for a period beginning 5 min before and ending 5 min after the first epinephrine administration. Results: A total of 56 epinephrine doses were analysed in 36 patients during CPR. The average rSO(2) value in the 5-min following epinephrine administration was 1.40% higher (95% CI = 0.41-2.40%; P = 0.0059) than in the 5-min period before epinephrine administration. However, there was no difference in the overall rate of change of rSO(2) when comparing the 5-min period before, with the 5-min period immediately after a single bolus dose of epinephrine (0.88%/min vs 1.07%/min respectively; P = 0.583), There was also no difference in the changes in rSO2 at individual 1, 2, 3, or 4-min time windows before and after a bolus dose of epinephrine (P = 0.5827, 0.2371, 0.2082, and 0.6707 respectively). Conclusions: A bolus of 1 mg epinephrine IV during CPR produced a small but clinically insignificant increase in rSO(2) in the five minutes after administration. This is the first clinical data to demonstrate the effects of epinephrine on cerebral rSO(2) during CPR. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

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