Wagner Henrik, Götberg Michael, Madsen Hardig Bjarne, Rundgren Malin, Carlson Jonas, Götberg Matthias, Zughaft David, Erlinge David, Olivecrona Göran K
Department of Cardiology, Lund University, Lund, Sweden.
BMC Cardiovasc Disord. 2014 Dec 20;14:199. doi: 10.1186/1471-2261-14-199.
In current guidelines, prolonged cardiopulmonary resuscitation (CPR) mandates administration of repeated intravenous epinephrine (EPI) doses. This porcine study simulating a prolonged CPR-situation in the coronary catheterisation laboratory, explores the effect of EPI-administrations on coronary perfusion pressure (CPP), continuous coronary artery flow average peak velocity (APV) and amplitude spectrum area (AMSA).
Thirty-six pigs were randomized 1:1:1 to EPI 0.02 mg/kg/dose, EPI 0.03 mg/kg/dose or saline (control) in an experimental cardiac arrest (CA) model. During 15 minutes of mechanical chest compressions, four EPI/saline-injections were administered, and the effect on CPP, APV and AMSA were recorded. Comparisons were performed between the control and the two EPI-groups and a combination of the two EPI-groups, EPI-all.
Compared to the control group, maximum peak of CPP (Pmax) after injection 1 and 2 was significantly increased in the EPI-all group (p = 0.022, p = 0.016), in EPI 0.02-group after injection 2 and 3 (p = 0.023, p = 0.027) and in EPI 0.03-group after injection 1 (p = 0.013). At Pmax, APV increased only after first injection in both the EPI-all and the EPI 0.03-group compared with the control group (p = 0.011, p = 0.018). There was no statistical difference of AMSA at any Pmax. Seven out of 12 animals (58%) in each EPI-group versus 10 out of 12 (83%) achieved spontaneous circulation after CA.
In an experimental CA-CPR pig model repeated doses of intravenous EPI results in a significant increase in APV only after the first injection despite increments in CPP also during the following 2 injections indicating inappropriate changes in coronary vascular resistance during subsequent EPI administration.
在当前指南中，延长心肺复苏（CPR）要求多次静脉注射肾上腺素（EPI）。这项猪实验模拟冠状动脉导管插入实验室中的延长CPR情况，探讨EPI给药对冠状动脉灌注压（CPP）、冠状动脉连续血流平均峰值速度（APV）和振幅频谱面积（AMSA）的影响。
在实验性心脏骤停（CA）模型中，将36头猪按1:1:1随机分为EPI 0.02 mg/kg/剂量组、EPI 0.03 mg/kg/剂量组或生理盐水（对照组）。在机械胸外按压15分钟期间，进行4次EPI/生理盐水注射，并记录对CPP、APV和AMSA的影响。在对照组与两个EPI组以及两个EPI组合并组（EPI-all）之间进行比较。
与对照组相比，EPI-all组注射1和2后CPP的最大峰值（Pmax）显著升高（p = 0.022，p = 0.016），EPI 0.02组注射2和3后（p = 0.023，p = 0.027）以及EPI 0.03组注射1后（p = 0.013）也显著升高。在Pmax时，与对照组相比，EPI-all组和EPI 0.03组仅在首次注射后APV增加（p = 0.011，p = 0.018）。在任何Pmax时，AMSA均无统计学差异。CA后，每个EPI组12只动物中有7只（58%）实现自主循环，而对照组12只中有10只（83%）。
在实验性CA-CPR猪模型中，尽管在随后的2次注射中CPP也有所增加，但多次静脉注射EPI仅在首次注射后导致APV显著增加，这表明在随后的EPI给药过程中冠状动脉血管阻力发生了不适当的变化。
