Abstract
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.
Highlights
Despite controversies, epinephrine remains a mainstay of cardiopulmonary resuscitation (CPR)
Epinephrine’s effect on cerebral blood flow (CBF) and cerebral tissue oxygenation decreased with subsequent doses, and by the fifth dose of epinephrine, there were no demonstrable increases in CBF or cerebral tissue oxygenation
The noninvasive measurements of CBF and cerebral tissue oxygenation directly correlated with invasive measurements, providing support for further translational and clinical investigations to determine the value of real-time noninvasive CBF and/or cerebral tissue oxygenation diffuse correlation spectroscopy (DCS)/diffuse optical spectroscopy (DOS) monitoring during CPR
Summary
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. In various pediatric and adult studies of cardiac arrest, early epinephrine administration was associated with increased rates of return of spontaneous circulation (ROSC) and improved neurological outcomes when compared with late administration [6,7,8,9]. Better delineation of the effect of epinephrine on CBF and cerebral tissue oxygenation during CPR is an important knowledge gap in the quest to improve both mortality and neurologic morbidity following cardiac arrest
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
