The effect of global ischemia and reperfusion on the plasma levels of vasoactive peptides. The neuroendocrine response to cardiac arrest and resuscitation.

Abstract

Return of spontaneous circulation with CPR is a function of coronary perfusion pressure, which is determined by vasomotor tone and the force of compression. Vasomotor tone is affected by the relative stimulation of arterial vasoconstricting and vasorelaxing receptors by vasoactive substances. We measured the plasma levels of the endogenous vasoactive peptides arginine vasopressin (AVP) angiotensin II (ANG-II) and atrial natriuretic peptide (ANP) during cardiac arrest and resuscitation. A fibrillatory canine model of canine arrest was used. 'Down time' was greater than 10 min, during which no therapy, including BLS, was given. Standard ACLS was initiated at the end of the down time with manual external chest compression standardized to an esophageal pulse pressure of 50 mmHg. Blood samples were collected through an aortic catheter during spontaneous circulation and 3 min after initiation of ACLS. Peptide levels were measured using standard RIA techniques. Results are reported as the mean +/- S.D. in pg/ml. AVP levels increased from a baseline of 1.7 +/- 1.0 pg/ml during spontaneous circulation to 29.9 +/- 33.3 during cardiac arrest and CPR (P = 0.01). There was a moderate positive correlation between aortic pressure and circulating AVP levels after the first dose of epinephrine (R = 0.5). There was a trend towards higher AVP levels in animals with return of spontaneous circulation (P = 0.12). ANG-II levels increased from a baseline of 14.7 +/- 12.9 pg/ml during spontaneous circulation to 151 +/- 105 during cardiac arrest and CPR (P < 0.05). ANP levels increased from a baseline of 55 +/- 46 pg/ml during spontaneous circulation to 293 +/- 73 during cardiac arrest and CPR (P < 0.01). There were significant increases in the levels of these endogenous vasoactive peptides. This reflects the neuroendocrine response to global ischemia and CPR reperfusion. Plasma levels of these peptides may effect the vital organ perfusion pressures, response to exogenous vasopressors, and outcome of resuscitative efforts. Future therapies may be directed at enhancing or blocking the effect of these peptides so as to optimize perfusion pressure which is one of the principle determinants of outcome during CPR.