Cardiovascular response to epinephrine varies with increasing duration of cardiac arrest

Mark G. Angelos, Ryan L. Butke, Ashish R. Panchal, Carlos A A Torres, Alan Blumberg, Jim E. Schneider, Sverre E. Aune

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Objective: Epinephrine (adrenaline) is widely used as a primary adjuvant for improving perfusion pressure and resuscitation rates during cardiopulmonary resuscitation (CPR). Epinephrine is also associated with significant myocardial dysfunction in the post-resuscitation period. We tested the hypothesis that the cardiac effects of epinephrine vary according to the duration of cardiac arrest. Methods and materials: Cardiac arrest (CA) was induced in Sprague-Dawley rats with an IV bolus of KCl (40 μg/g). Three series of experiments were performed with CPR begun after 2, 4, or 6 min of cardiac arrest. Epinephrine (0.01 mg/kg) IV or placebo was given immediately in the 2 and 4 min CA groups. In the 6 min group, CPR was started after 6 min CA and epinephrine was given at 15 min if no return of spontaneous circulation (ROSC) occurred. Time to ROSC was recorded in all groups. Cardiac function was determined with trans-thoracic echocardiography at baseline, 5, 30 and 60 min after ROSC. Results: After 2 min CA, 8/8 (100%) placebo animals and 8/8 (100%) epinephrine animals attained ROSC. Cardiac index was significantly increased during the first 60 min in the epinephrine group compared with the placebo group (p < 0.01). After 4 min of cardiac arrest, 14/29 (48%) placebo animals and 14/16 (88%) epinephrine animals attained ROSC (p < 0.01). Cardiac index after ROSC returned to baseline in both groups, although tended to be lower in the epinephrine group. After 6 min CA, 10/31 (32%) animals attained ROSC without epinephrine and 17/21 (81%) animals with epinephrine (p < 0.01). Post-ROSC depression of cardiac index was greatest in the epinephrine group (p < 0.05). Conclusions: As the duration of cardiac arrest increases, a paradoxical myocardial epinephrine response develops, in which epinephrine becomes increasingly more important to attain ROSC, but is increasingly associated with post-ROSC myocardial depression.

Original languageEnglish (US)
Pages (from-to)101-110
Number of pages10
JournalResuscitation
Volume77
Issue number1
DOIs
StatePublished - Apr 2008
Externally publishedYes

Fingerprint

Heart Arrest
Epinephrine
Cardiopulmonary Resuscitation
Placebos
Resuscitation
Induced Heart Arrest
Sprague Dawley Rats
Echocardiography
Thorax
Perfusion

Keywords

  • Adrenaline
  • Cardiopulmonary resuscitation (CPR)
  • Epinephrine
  • Post-resuscitation period
  • Return of spontaneous circulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Angelos, M. G., Butke, R. L., Panchal, A. R., Torres, C. A. A., Blumberg, A., Schneider, J. E., & Aune, S. E. (2008). Cardiovascular response to epinephrine varies with increasing duration of cardiac arrest. Resuscitation, 77(1), 101-110. https://doi.org/10.1016/j.resuscitation.2007.10.017

Cardiovascular response to epinephrine varies with increasing duration of cardiac arrest. / Angelos, Mark G.; Butke, Ryan L.; Panchal, Ashish R.; Torres, Carlos A A; Blumberg, Alan; Schneider, Jim E.; Aune, Sverre E.

In: Resuscitation, Vol. 77, No. 1, 04.2008, p. 101-110.

Research output: Contribution to journalArticle

Angelos, MG, Butke, RL, Panchal, AR, Torres, CAA, Blumberg, A, Schneider, JE & Aune, SE 2008, 'Cardiovascular response to epinephrine varies with increasing duration of cardiac arrest', Resuscitation, vol. 77, no. 1, pp. 101-110. https://doi.org/10.1016/j.resuscitation.2007.10.017
Angelos MG, Butke RL, Panchal AR, Torres CAA, Blumberg A, Schneider JE et al. Cardiovascular response to epinephrine varies with increasing duration of cardiac arrest. Resuscitation. 2008 Apr;77(1):101-110. https://doi.org/10.1016/j.resuscitation.2007.10.017
Angelos, Mark G. ; Butke, Ryan L. ; Panchal, Ashish R. ; Torres, Carlos A A ; Blumberg, Alan ; Schneider, Jim E. ; Aune, Sverre E. / Cardiovascular response to epinephrine varies with increasing duration of cardiac arrest. In: Resuscitation. 2008 ; Vol. 77, No. 1. pp. 101-110.
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abstract = "Objective: Epinephrine (adrenaline) is widely used as a primary adjuvant for improving perfusion pressure and resuscitation rates during cardiopulmonary resuscitation (CPR). Epinephrine is also associated with significant myocardial dysfunction in the post-resuscitation period. We tested the hypothesis that the cardiac effects of epinephrine vary according to the duration of cardiac arrest. Methods and materials: Cardiac arrest (CA) was induced in Sprague-Dawley rats with an IV bolus of KCl (40 μg/g). Three series of experiments were performed with CPR begun after 2, 4, or 6 min of cardiac arrest. Epinephrine (0.01 mg/kg) IV or placebo was given immediately in the 2 and 4 min CA groups. In the 6 min group, CPR was started after 6 min CA and epinephrine was given at 15 min if no return of spontaneous circulation (ROSC) occurred. Time to ROSC was recorded in all groups. Cardiac function was determined with trans-thoracic echocardiography at baseline, 5, 30 and 60 min after ROSC. Results: After 2 min CA, 8/8 (100{\%}) placebo animals and 8/8 (100{\%}) epinephrine animals attained ROSC. Cardiac index was significantly increased during the first 60 min in the epinephrine group compared with the placebo group (p < 0.01). After 4 min of cardiac arrest, 14/29 (48{\%}) placebo animals and 14/16 (88{\%}) epinephrine animals attained ROSC (p < 0.01). Cardiac index after ROSC returned to baseline in both groups, although tended to be lower in the epinephrine group. After 6 min CA, 10/31 (32{\%}) animals attained ROSC without epinephrine and 17/21 (81{\%}) animals with epinephrine (p < 0.01). Post-ROSC depression of cardiac index was greatest in the epinephrine group (p < 0.05). Conclusions: As the duration of cardiac arrest increases, a paradoxical myocardial epinephrine response develops, in which epinephrine becomes increasingly more important to attain ROSC, but is increasingly associated with post-ROSC myocardial depression.",
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AU - Butke, Ryan L.

AU - Panchal, Ashish R.

AU - Torres, Carlos A A

AU - Blumberg, Alan

AU - Schneider, Jim E.

AU - Aune, Sverre E.

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N2 - Objective: Epinephrine (adrenaline) is widely used as a primary adjuvant for improving perfusion pressure and resuscitation rates during cardiopulmonary resuscitation (CPR). Epinephrine is also associated with significant myocardial dysfunction in the post-resuscitation period. We tested the hypothesis that the cardiac effects of epinephrine vary according to the duration of cardiac arrest. Methods and materials: Cardiac arrest (CA) was induced in Sprague-Dawley rats with an IV bolus of KCl (40 μg/g). Three series of experiments were performed with CPR begun after 2, 4, or 6 min of cardiac arrest. Epinephrine (0.01 mg/kg) IV or placebo was given immediately in the 2 and 4 min CA groups. In the 6 min group, CPR was started after 6 min CA and epinephrine was given at 15 min if no return of spontaneous circulation (ROSC) occurred. Time to ROSC was recorded in all groups. Cardiac function was determined with trans-thoracic echocardiography at baseline, 5, 30 and 60 min after ROSC. Results: After 2 min CA, 8/8 (100%) placebo animals and 8/8 (100%) epinephrine animals attained ROSC. Cardiac index was significantly increased during the first 60 min in the epinephrine group compared with the placebo group (p < 0.01). After 4 min of cardiac arrest, 14/29 (48%) placebo animals and 14/16 (88%) epinephrine animals attained ROSC (p < 0.01). Cardiac index after ROSC returned to baseline in both groups, although tended to be lower in the epinephrine group. After 6 min CA, 10/31 (32%) animals attained ROSC without epinephrine and 17/21 (81%) animals with epinephrine (p < 0.01). Post-ROSC depression of cardiac index was greatest in the epinephrine group (p < 0.05). Conclusions: As the duration of cardiac arrest increases, a paradoxical myocardial epinephrine response develops, in which epinephrine becomes increasingly more important to attain ROSC, but is increasingly associated with post-ROSC myocardial depression.

AB - Objective: Epinephrine (adrenaline) is widely used as a primary adjuvant for improving perfusion pressure and resuscitation rates during cardiopulmonary resuscitation (CPR). Epinephrine is also associated with significant myocardial dysfunction in the post-resuscitation period. We tested the hypothesis that the cardiac effects of epinephrine vary according to the duration of cardiac arrest. Methods and materials: Cardiac arrest (CA) was induced in Sprague-Dawley rats with an IV bolus of KCl (40 μg/g). Three series of experiments were performed with CPR begun after 2, 4, or 6 min of cardiac arrest. Epinephrine (0.01 mg/kg) IV or placebo was given immediately in the 2 and 4 min CA groups. In the 6 min group, CPR was started after 6 min CA and epinephrine was given at 15 min if no return of spontaneous circulation (ROSC) occurred. Time to ROSC was recorded in all groups. Cardiac function was determined with trans-thoracic echocardiography at baseline, 5, 30 and 60 min after ROSC. Results: After 2 min CA, 8/8 (100%) placebo animals and 8/8 (100%) epinephrine animals attained ROSC. Cardiac index was significantly increased during the first 60 min in the epinephrine group compared with the placebo group (p < 0.01). After 4 min of cardiac arrest, 14/29 (48%) placebo animals and 14/16 (88%) epinephrine animals attained ROSC (p < 0.01). Cardiac index after ROSC returned to baseline in both groups, although tended to be lower in the epinephrine group. After 6 min CA, 10/31 (32%) animals attained ROSC without epinephrine and 17/21 (81%) animals with epinephrine (p < 0.01). Post-ROSC depression of cardiac index was greatest in the epinephrine group (p < 0.05). Conclusions: As the duration of cardiac arrest increases, a paradoxical myocardial epinephrine response develops, in which epinephrine becomes increasingly more important to attain ROSC, but is increasingly associated with post-ROSC myocardial depression.

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KW - Cardiopulmonary resuscitation (CPR)

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KW - Post-resuscitation period

KW - Return of spontaneous circulation

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