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Vasopressin versus continuous adrenaline during experimental cardiopulmonary resuscitation
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
2004 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 62, no 1, 61-69 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effects of a bolus dose of vasopressin compared to continuous adrenaline (epinephrine) infusion on vital organ blood flow during cardiopulmonary resuscitation (CPR). Methods: Ventricular fibrillation was induced in 24 anaesthetised pigs. After a 5-min non-intervention interval, CPR was started. After 2 min of CPR the animals were randomly assigned to receive either vasopressin (0.4 U/kg) or adrenaline (bolus of 20 μg/kg followed by continuous infusion of 10 μg/(kg min)). Defibrillation was attempted after 9 min of CPR. Results: Vasopressin generated higher cortical cerebral blood flow (P<0.001) and lower cerebral oxygen extraction (P<0.001) during CPR compared to continuous adrenaline. Coronary perfusion pressure during CPR was higher in vasopressin-treated pigs (P<0.001) and successful resuscitation was achieved in 12/12 in the vasopressin group versus 5/12 in the adrenaline group (P=0.005). Conclusions: In this experimental model, vasopressin caused a greater increase in cortical cerebral blood flow and lower cerebral oxygen extraction during CPR compared to continuous adrenaline. Furthermore, vasopressin generated higher coronary perfusion pressure and increased the likelihood of restoring spontaneous circulation.

Place, publisher, year, edition, pages
2004. Vol. 62, no 1, 61-69 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-91828DOI: 10.1016/j.resuscitation.2004.01.034PubMedID: 15246585OAI: oai:DiVA.org:uu-91828DiVA: diva2:164685
Available from: 2004-05-07 Created: 2004-05-07 Last updated: 2013-05-15Bibliographically approved
In thesis
1. Cardiopulmonary Resuscitation: Pharmacological Interventions for Augmentation of Cerebral Blood Flow
Open this publication in new window or tab >>Cardiopulmonary Resuscitation: Pharmacological Interventions for Augmentation of Cerebral Blood Flow
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cardiac arrest results in immediate interruption of blood flow. The primary goal of cardiopulmonary resuscitation (CPR) is to re-establish blood flow and hence oxygen delivery to the vital organs. This thesis describes different pharmacological interventions aimed at increasing cerebral blood flow during CPR and after restoration of spontaneous circulation (ROSC).

In a porcine model of cardiac arrest, continuous infusion of adrenaline generated higher cortical cerebral blood flow during CPR as compared to bolus administration of adrenaline. While bolus doses resulted in temporary peaks in cerebral blood flow, continuous infusion led to a sustained increase in this flow.

Administration of vasopressin resulted in higher cortical cerebral blood flow and a lower cerebral oxygen extraction ratio as compared to continuous infusion of adrenaline during CPR. In addition, vasopressin generated higher coronary perfusion pressure during CPR and increased the likelihood of achieving ROSC.

Parameters of coagulation and inflammation were measured after successful resuscitation from cardiac arrest. Immediately after ROSC, thrombin-antithrombin complex, a marker of thrombin generation, was elevated and eicosanoid levels were increased, indicating activation of coagulation and inflammation after ROSC. The thrombin generation was accompanied by a reduction in antithrombin. In addition, there was substantial haemoconcentration in the initial period after ROSC.

By administration of antithrombin during CPR, supraphysiological levels of antithrombin were achieved. However, antithrombin administration did not increase cerebral circulation or reduce reperfusion injury, as measured by cortical cerebral blood flow, cerebral oxygen extraction and levels of eicosanoids, after ROSC.

In a clinical study, the adrenaline dose interval was found to be longer than recommended in the majority of cases of cardiac arrest. Thus, the adherence to recommended guidelines regarding the adrenaline dose interval seems to be poor.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2004. 59 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1355
Keyword
Anaesthesiology and intensive care, Adrenaline (epinephrine), Cardiac arrest, Cardiopulmonary resuscitation, Cerebral blood flow, Guidelines, Post-resuscitation period, Vasopressin, Anestesiologi och intensivvård
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-4281 (URN)91-554-5981-1 (ISBN)
Public defence
2004-06-02, Hedstrandsalen, Akademiska Sjukhuset ing. 70, Uppsala, 09:15
Opponent
Supervisors
Available from: 2004-05-07 Created: 2004-05-07Bibliographically approved

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Johansson, JakobGedeborg, RolfRubertsson, Sten

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