The effects of epinephrine/norepinephrine on end-tidal carbon dioxide concentration, coronary perfusion pressure and pulmonary arterial blood flow during cardiopulmonary resuscitation

Abstract

End-tidal CO 2 concentration correlates with pulmonary blood flow during cardiopulmonary resuscitation and has been claimed to be a useful tool to judge the effectiveness of chest compression. A high concentration of end-tidal CO 2 has been related to a better outcome. However, most authors have noticed a decrease in end-tidal CO 2 concentration after administration of epinephrine, concomitant with an increase in coronary perfusion pressure and an increased incidence of return of spontaneous circulation. This study was performed to evaluate changes in end-tidal CO 2 concentration after injection of vasopressors during cardiopulmonary resuscitation and to investigate the time-course of the response and possible explanations for it. After 1 min of electrically induced cardiac arrest and 5 min of chest compressions, 18 pigs were randomly assigned to receive 0.045 mg kg −1 epinephrine, 0.045 mg kg −1 norepinephrine or no drug. After another 4 min of chest compressions the pigs were defibrillated. End-tidal CO 2, pulmonary blood flow and coronary perfusion pressure decreased immediately after the induction of cardiac arrest, increased slightly during chest compressions and increased initially to supernormal levels after the return of spontaneous circulation. Injection of epinephrine or norepinephrine during chest compressions decreased end-tidal CO 2 51±2%, (mean±S.E.M.), and 43±1%, respectively, and pulmonary blood flow by 134±13 and 125±16%, respectively, within 1 min, simultaneously increasing coronary perfusion pressure from 10±2 to 45±5 mm Hg and from 11±1 to 38±5 mm Hg, respectively. The coronary perfusion pressure slowly fell, but the effects on end-tidal CO 2 and pulmonary blood flow were prolonged. In conclusion, vasopressors increased coronary perfusion pressure and the likelihood of a return of spontaneous circulation, but decreased end-tidal CO 2 concentration and induced a critical deterioration in cardiac output and thus oxygen delivery in this model of cardiopulmonary resuscitation.