Does prearrest adrenergic integrity affect pressor response? A comparison of epinephrine and vasopressin in a spontaneous ventricular fibrillation swine model

RESUSCITATION

卷:82

Article

Youngquist, Scott T.^1,2  Shah, Atman³  McClung, Christian⁴  Thomas, Joseph L.⁵  Rosborough, John P.⁶  Niemann, James T.⁶ 

[1] Univ Utah, Div Emergency Med, Dept Surg, Salt Lake City, UT 84132 USA

[2] Univ Utah, Sch Med, Air Med Res Inst, Salt Lake City, UT 84132 USA

[3] Univ Chicago, Dept Med, Div Cardiol, Chicago, IL 60637 USA

[4] Los Angeles Cty Univ So Calif, Med Ctr, Dept Emergency Med, Los Angeles, CA USA

[5] Harbor UCLA Med Ctr, Dept Med, Div Cardiol, Torrance, CA 90509 USA

[6] Harbor UCLA Med Ctr, Dept Emergency Med, Torrance, CA 90509 USA

关键词: Cardiac arrest;    Cardiopulmonary resuscitation;    Beta-blockers;    Coronary perfusion pressure;   

DOI  :  10.1016/j.resuscitation.2010.10.004

来源: Elsevier

【 摘 要 】

Objectives: Coronary perfusion pressure (CPP) during resuscitation from cardiac arrest has been shown to correlate with return of spontaneous circulation. Adrenergic blockade of beta-1 and alpha-1 receptors is common in the long-term management of ischemic heart disease and congestive heart failure. We sought to compare the CPP response to vasopressin vs. epinephrine in a swine model of cardiac arrest following pre-arrest adrenergic blockade. Methods: Eight anesthetized and instrumented swine were administered 0.1 mg epinephrine and arterial pressure and heart rate response were measured. An infusion of labetalol was then initiated and animals periodically challenged with epinephrine until adrenergic blockade was confirmed. The left anterior descending coronary artery was occluded to produce ventricular fibrillation (VF). After 7 min of untreated VF, mechanical chest compressions were initiated. After 1 min of compressions, 1 mg epinephrine was given while CPP was recorded. When CPP values had returned to pre-epinephrine levels, 40U of bolus vasopressin was given. Differences in CPP (post-vasopressor-pre-vasopressor) were compared within animals for the epinephrine and vasopressin response and with eight, non-adrenergically blocked, historical controls using Bayesian statistics with a non-informative prior. Results: The CPP response following epinephrine was 15.1 mmHg lower in adrenergically blocked animals compared to non-adrenergically blocked animals (95% Highest Posterior Density [HPD] 2.9-27.2 mmHg lower). CPP went up 18.4 mmHg more following vasopressin when compared to epinephrine (95% HPD 8.2-29.1 mmHg). The posterior probability of a higher CPP response from vasopressin (vs. epinephrine) in these animals was 0.999. Conclusions: Pre-arrest adrenergic blockade blunts the CPP response to epinephrine. Superior augmentation of CPP is attained with vasopressin under these conditions. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

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