Mauch Jacqueline, Ringer Simone K, Spielmann Nelly, Weiss Markus
Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
Paediatr Anaesth. 2013 Oct;23(10):906-12. doi: 10.1111/pan.12149. Epub 2013 Apr 1.
Early epinephrine administration in cardiac arrest seems to be advantageous to achieve return of spontaneous circulation (ROSC). Because intravenous (i.v.) or intraosseous access is not always immediately available, this study compares efficacy of early intramuscular (i.m.) epinephrine administration with early and delayed i.v. epinephrine injection in an animal cardiac arrest model.
Piglets anesthetized with sevoflurane were intoxicated by an i.v. ropivacaine infusion until circulatory arrest. After 1 min basic life support (chest compression and ventilation), epinephrine i.v. (10 μg·kg(-1), group IV) or epinephrine i.m. (100 μg·kg(-1), group IM) or normal saline (group NS) was applied. Further doses of epinephrine were given in group IV every 4 min and in group IM after 10 min if required. Twenty-one minutes after circulatory arrest, i.v. epinephrine - as necessary - was given to all animals. Thus, group NS represents late epinephrine administration. Outcomes were survival and time to ROSC.
Twenty-four pigs aged 19.5 (median, interquartile range 16-22) days, weighing 5.4 (5.0-5.7) kg were investigated. Total amount of ropivacaine administered was 8.9 (8.1-10.1) mg·kg(-1). Cardiac rhythm before starting CPR was pulseless electric activity and asystole in 15 and 9 pigs, respectively. Eight, seven, and four pigs survived in group IV, IM, and NS. Focusing on surviving animals, time to ROSC was 2, 4 and 19.5 min in group IV, IM, and NS.
Early i.m. epinephrine provided similar survival compared with early i.v. epinephrine and was superior to delayed epinephrine administration in resuscitation of ropivacaine-induced cardiac arrest in piglets.
心脏骤停时早期使用肾上腺素似乎有利于实现自主循环恢复（ROSC）。由于静脉内（i.v.）或骨内给药途径并非总是能立即实现，本研究在动物心脏骤停模型中比较了早期肌肉内（i.m.）注射肾上腺素与早期和延迟静脉注射肾上腺素的疗效。
用七氟醚麻醉的仔猪通过静脉输注罗哌卡因直至循环骤停。在进行1分钟基础生命支持（胸外按压和通气）后，静脉注射肾上腺素（10μg·kg⁻¹，IV组）或肌肉注射肾上腺素（100μg·kg⁻¹，IM组）或生理盐水（NS组）。IV组每4分钟给予进一步剂量的肾上腺素，IM组如有需要在10分钟后给予。循环骤停21分钟后，根据需要对所有动物给予静脉肾上腺素。因此，NS组代表延迟给予肾上腺素。观察指标为生存率和至ROSC的时间。
研究了24头年龄为19.5（中位数，四分位数间距16 - 22）天、体重5.4（5.0 - 5.7）kg的仔猪。罗哌卡因的总给药量为8.9（8.1 - 10.1）mg·kg⁻¹。开始心肺复苏前的心律在15头和9头猪中分别为无脉电活动和心脏停搏。IV组、IM组和NS组分别有8头、7头和4头猪存活。聚焦于存活动物，IV组、IM组和NS组至ROSC的时间分别为2分钟、4分钟和19.5分钟。
在仔猪罗哌卡因诱导的心脏骤停复苏中，早期肌肉注射肾上腺素与早期静脉注射肾上腺素的生存率相似，且优于延迟给予肾上腺素。
