Mauch Jacqueline, Ringer Simone, Spielmann Nelly, Weiss Markus
Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland; Department of Anesthesia and Perioperative Medicine, Kantonsspital Aarau, Tellstrasse, Aarau, Switzerland.
Paediatr Anaesth. 2014 Sep;24(9):933-9. doi: 10.1111/pan.12457. Epub 2014 Jun 26.
Early intravenous epinephrine administration may help to achieve return of spontaneous circulation in cardiac arrest (CA). However, venous access can be challenging in small children. This study investigates the effect of intravenous and intramuscular epinephrine in treatment of asphyxial CA.
Twenty-eight, 2-5-weeks-old, anesthetized piglets were asphyxiated by ventilation withdrawal. CA was untreated for 8 min, followed by 2 min of basic life support. Following this, epinephrine iv (10 μg·kg(-1) , group IV), epinephrine im (100 μg·kg(-1) , group IM), or normal saline (group NS) were administered. Further doses of epinephrine were given in group IV every 4 min, in group IM after 10 min if required. After twenty-two minutes of CA, iv epinephrine was given to all animals still in CA. Outcome measures were survival and epinephrine plasma concentrations.
Ten animals regained spontaneous circulation after 2 min of basic life support. Therefore, no drug treatment was administered (drop out). Resuscitation was effective in 2 pigs of group IM (n = 6), in 6 of group NS (n = 8) and in all of group IV (n = 4). Nonsurvivors had higher epinephrine (P < 0.01) and norepinephrine (P < 0.01) plasma concentrations prior to start of resuscitation. Median increase in epinephrine plasma concentration from T0 to T5 was 138, 134, and 29 nm in group IV, IM, and NS, respectively.
Intravenous and intramuscular administered epinephrine led to similar increase in plasma concentrations during resuscitation of asphyxial CA without hemodynamic or survival benefit. High endogenous epinephrine and norepinephrine plasma concentrations were negative predictors for survival.
早期静脉注射肾上腺素可能有助于心脏骤停（CA）患者恢复自主循环。然而，在幼儿中建立静脉通路可能具有挑战性。本研究探讨静脉注射和肌肉注射肾上腺素治疗窒息性心脏骤停的效果。
28只2至5周龄的麻醉仔猪通过停止通气造成窒息。心脏骤停8分钟未治疗，随后进行2分钟的基础生命支持。在此之后，静脉注射肾上腺素（10μg·kg⁻¹，IV组）、肌肉注射肾上腺素（100μg·kg⁻¹，IM组）或生理盐水（NS组）。IV组每4分钟给予额外剂量的肾上腺素，IM组如有需要在10分钟后给予。心脏骤停22分钟后，仍处于心脏骤停状态的所有动物均给予静脉注射肾上腺素。观察指标为生存率和肾上腺素血浆浓度。
10只动物在2分钟基础生命支持后恢复自主循环。因此，未给予药物治疗（退出研究）。IM组2只猪（n = 6）、NS组6只猪（n = 8）和IV组所有猪（n = 4）复苏成功。未存活者在复苏开始前肾上腺素（P < 0.01）和去甲肾上腺素（P < 0.01）血浆浓度较高。从T0到T5，IV组、IM组和NS组肾上腺素血浆浓度的中位数增加分别为138、134和29nmol/L。
在窒息性心脏骤停复苏过程中，静脉注射和肌肉注射肾上腺素导致血浆浓度的升高相似，但无血流动力学或生存获益。内源性肾上腺素和去甲肾上腺素血浆浓度高是生存的负性预测指标。
