Berg R A, Otto C W, Kern K B, Hilwig R W, Sanders A B, Henry C P, Ewy G A
Department of Pediatrics, Steele Memorial Children's Research Center, Tucson, AZ, USA.
Crit Care Med. 1996 Oct;24(10):1695-700. doi: 10.1097/00003246-199610000-00016.
To determine whether high-dose epinephrine administration during cardiopulmonary resuscitation (CPR) in a swine pediatric asphyxial cardiac arrest model improves outcome (i.e., resuscitation rate, survival rate, and neurologic function) compared with standard-dose epinephrine.
A randomized, blinded study.
A large animal cardiovascular laboratory at a university.
Thirty domestic piglets (3 to 4 months of age) were randomized to receive standard-dose epinephrine (0.02 mg/kg) or high-dose epinephrine (0.2 mg/kg) during CPR after 10 mins of cardiac standstill with loss of aortic pulsation after endotracheal tube clamping.
Two minutes of CPR were provided, followed by advanced pediatric life support. Successfully resuscitated animals were supported in an intensive care unit (ICU) setting for 2 hrs and then observed for 24 hrs.
Electrocardiogram, thoracic aortic blood pressure, and right atrial blood pressure were monitored continuously until the intensive care period ended. Survival rate and neurologic outcome were determined. Return of spontaneous circulation was obtained in 13 of 15 high-dose epinephrine piglets vs. ten of 15 standard-dose epinephrine piglets (p < .20). Four of 13 high-dose piglets died in the ICU period after initial resuscitation vs. 0 of ten standard-dose piglets (p < or = .05). Nine high-dose piglets survived 2 hrs vs. ten standard-dose piglets. Three piglets in each group survived for 24 hrs, but all were severely neurologically impaired. Two minutes after resuscitation, piglets treated with high-dose epinephrine had higher heart rates (210 +/- 24 vs. 189 +/- 40 beats/min, p < .05) and higher aortic diastolic pressures (121 +/- 39 vs. 74 +/- 40 mm Hg, p < .01). Within 10 mins of return of spontaneous circulation, severe tachycardia (> 240 beats/min) was more frequently noted in the high-dose group than in the standard-dose group (p < .05). All four high-dose piglets that died in the ICU period experienced ventricular fibrillation within 10 mins of return of spontaneous circulation.
High-dose epinephrine did not improve 2-hr survival rate, 24-hr survival rate, or neurologic outcome. High-dose epinephrine resulted in severe tachycardia and hypertension immediately after resuscitation and in a higher mortality rate immediately after resuscitation.
在猪小儿窒息性心脏骤停模型中，确定与标准剂量肾上腺素相比，心肺复苏（CPR）期间给予大剂量肾上腺素是否能改善预后（即复苏率、生存率和神经功能）。
一项随机、盲法研究。
一所大学的大型动物心血管实验室。
30只家猪（3至4月龄），在气管插管夹闭后出现心脏停搏10分钟且主动脉搏动消失后，随机分为在CPR期间接受标准剂量肾上腺素（0.02mg/kg）或大剂量肾上腺素（0.2mg/kg）治疗。
进行2分钟的CPR，随后进行高级儿科生命支持。成功复苏的动物在重症监护病房（ICU）环境中支持2小时，然后观察24小时。
持续监测心电图、胸主动脉血压和右心房血压，直至重症监护期结束。确定生存率和神经功能结局。15只接受大剂量肾上腺素治疗的仔猪中有13只恢复自主循环，而15只接受标准剂量肾上腺素治疗的仔猪中有10只恢复自主循环（p<0.20）。13只接受大剂量肾上腺素治疗的仔猪中有4只在初始复苏后的ICU期间死亡，而10只接受标准剂量肾上腺素治疗的仔猪中无死亡（p≤0.05）。9只接受大剂量肾上腺素治疗的仔猪存活2小时；10只接受标准剂量肾上腺素治疗的仔猪存活2小时。每组有3只仔猪存活24小时，但均有严重的神经功能损害。复苏后2分钟，接受大剂量肾上腺素治疗的仔猪心率较高（210±24次/分钟对189±40次/分钟，p<0.05），主动脉舒张压较高（121±39mmHg对74±40mmHg，p<0.01）。在恢复自主循环后10分钟内，大剂量组比标准剂量组更频繁地出现严重心动过速（>240次/分钟）（p<0.05）。在ICU期间死亡的4只接受大剂量肾上腺素治疗的仔猪在恢复自主循环后10分钟内均发生室颤。
大剂量肾上腺素并未改善2小时生存率及24小时生存率或神经功能结局。大剂量肾上腺素在复苏后立即导致严重心动过速和高血压，并在复苏后立即导致较高的死亡率。
