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

• Published in: Resuscitation Vol. 82; no. 7; pp. 932 - 936
• Main Authors: Jeung, Kyung Woon, Ryu, Hyun Ho, Song, Kyung Hwan, Lee, Byung Kook, Lee, Hyoung Youn, Heo, Tag, Min, Yong Il
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-07-2011; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Disease Models, Animal; Dose-Response Relationship, Drug; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Epinephrine - administration & dosage; Follow-Up Studies; Heart arrest; Heart Arrest - physiopathology; Heart Arrest - therapy; Hemodynamics - drug effects; High-dose epinephrine; Intensive care medicine; Male; Medical sciences; Outcome; Recovery of Function - drug effects; Return of spontaneous circulation; Swine; Time Factors; Treatment Outcome; Vasoconstrictor Agents - administration & dosage; Heart arrest; High-dose epinephrine; Return of spontaneous circulation; Cardiopulmonary resuscitation; Outcome; Epinephrine; Cardiocirculatory arrest; Intensive care; Prognosis; Cardiovascular disease; Catecholamine; Neurotransmitter; High dose; Resuscitation
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2011.03.007

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 0.2 mg/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.