Abstract
Adrenaline is recommended for cardiac arrest resuscitation, but its effectiveness has been questioned recently. Achieving return of spontaneous circulation (ROSC) is essential and is obtained by increasing coronary perfusion pressure (CPP) after adrenaline injection. A threshold as high as 35 mmHg of CPP may be necessary to obtain ROSC, but increasing doses of adrenaline might be harmful to the brain. Our study aimed to compare the increase in CPP with reduced doses of adrenaline to the recommended 1 mg dose in a pig model of cardiac arrest. Fifteen domestic pigs were randomized into three groups according to the adrenaline doses: 1 mg, 0.5 mg, or 0.25 mg administered every 5 min. Cardiac arrest was induced by ventricular fibrillation; after 5 min of no-flow, mechanical chest compression was resumed. The Wilcoxon test and Kruskal–Wallis exact test were used for the comparison of groups. Fisher’s exact test was used to compare categorical variables. CPP, EtCO2 level, cerebral, and tissue near-infrared spectroscopy (NIRS) were measured. CPP was significantly lower in the 0.25 mg group 90 s after the first adrenaline injection: 28.9 (21.2; 35.4) vs. 53.8 (37.8; 58.2) in the 1 mg group (p = 0.008), while there was no significant difference with 0.5 mg 39.6 (32.7; 52.5) (p = 0.056). Overall, 0.25 mg did not achieve the threshold of 35 mmHg. EtCO2 levels were higher at T12 and T14 in the 0.5 mg than in the standard group: 32 (23; 35) vs. 19 (16; 26) and 26 (20; 34) vs. 19 (12; 22) (p < 0.05). Cerebral and tissue NIRS did not show a significant difference between the three groups. CPP after 0.5 mg boluses of adrenaline was not significantly different from the recommended 1 mg in our model of cardiac arrest.
Highlights
Licensee MDPI, Basel, Switzerland.Cardiac arrest is a leading cause of death and neurological impairment
This study has shown that a 0.5 mg adrenaline bolus increases coronary perfusion pressure (CPP) after 90 s to the same level as the standard dose of 1 mg in a pig cardiac arrest model, using mechanical compression
Because that value remains uncertain, it was assumed that the recommendation of 1 mg of adrenaline was sufficient to achieve return of spontaneous circulation (ROSC) [24], and the goal was to determine if reduced adrenaline doses could reach the same CPP levels as 1 mg
Summary
Cardiac arrest is a leading cause of death and neurological impairment. Survival rates are low—around 8% in Europe—and over 50,000 people die of cardiac arrest every year in France [1,2]. The risk of severe neurological impairment is a serious public health issue, the exact cost remains unknown [3]. The European Resuscitation Council recommends administering 1 mg of adrenaline every 3 to 5 min during cardio-pulmonary resuscitation (CPR) [4].
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