Wagner Henrik, Mlček Mikuláš, Krupičková Petra, Popkova Michaela, Mejstrik Alan, Boucek Tomas, Michálek Pavel, Kittnar Otomar, Belohlavek Jan
Department of Cardiology, Skane University Hospital, Lund, Sweden.
Clinical Sciences, Section II, Faculty of Medicine, Lund University, Helsingborg, Sweden.
Resusc Plus. 2025 Feb 4;22:100893. doi: 10.1016/j.resplu.2025.100893. eCollection 2025 Mar.
Adrenaline (ADR) is a cornerstone of advanced life support (ALS) in cardiac arrest (CA), although its neurologically favourable survival outcomes remain unclear. ADR increases coronary perfusion pressure (CPP), with levels >15 mmHg associated with successful defibrillation. This study aimed to elucidate the relationship between ADR, myocardial microvascular blood flow, and resuscitation outcomes using a porcine CA model simulating refractory ventricular fibrillation (VF).
This study involved 24 domestic pigs. After instrumentation, intubation, and baseline measurements, the animals were randomised into the ADR or control (saline) groups. VF was induced, and cardiopulmonary resuscitation was initiated using continuous mechanical chest compressions and ventilation. ADR or saline was administered following ALS guidelines. After 21 min of ALS, defibrillation was performed. Continuous measurements of arterial and venous blood pressures using an electrocardiogram and index of myocardial resistance (IMR) and transit mean time (Tmn) 1 min before and after each injection or peak blood pressure were recorded and compared between the groups. CPP-IMR, amplitude spectrum area (AMSA)-IMR, CPP-Tmn, and AMSA-Tmn correlations were assessed.
Compared with six animals in the control group, three in the ADR group achieved a return of spontaneous circulation. No difference was observed in IMR or AMSA; however, significant increases in CPP and arterial end-diastolic blood pressure were observed at several time points. Tmn differed between groups only at two time points.
Repeated ADR doses during prolonged ALS simulating refractory VF did not improve myocardial microvascular blood flow, as measured using IMR, despite leading to an increase in CPP.
肾上腺素（ADR）是心脏骤停（CA）高级生命支持（ALS）的基石，尽管其对神经功能有益的生存结果尚不清楚。ADR可增加冠状动脉灌注压（CPP），CPP>15 mmHg与成功除颤相关。本研究旨在使用模拟难治性室颤（VF）的猪CA模型阐明ADR、心肌微血管血流和复苏结果之间的关系。
本研究涉及24头家猪。在进行仪器植入、插管和基线测量后，将动物随机分为ADR组或对照组（生理盐水）。诱发VF，并使用持续机械胸外按压和通气开始心肺复苏。按照ALS指南给予ADR或生理盐水。在ALS进行21分钟后进行除颤。在每次注射前1分钟和注射后或血压峰值时，使用心电图连续测量动脉和静脉血压，并记录心肌阻力指数（IMR）和通过平均时间（Tmn），并在组间进行比较。评估CPP-IMR、振幅频谱面积（AMSA）-IMR、CPP-Tmn和AMSA-Tmn的相关性。
与对照组的6只动物相比，ADR组有3只实现了自主循环恢复。IMR或AMSA未观察到差异；然而，在几个时间点观察到CPP和动脉舒张末期血压显著升高。Tmn仅在两个时间点在组间存在差异。
在模拟难治性VF的长时间ALS过程中，重复给予ADR剂量并未改善使用IMR测量的心肌微血管血流，尽管导致了CPP的增加。
