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Adrenaline administration during cardiopulmonary resuscitation: poor adherence to clinical guidelines
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 Medical Sciences, Cardiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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2004 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 48, no 7, 909-913 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Adrenaline does not appear to improve the outcome after cardiac arrest in clinical trials in spite of beneficial effects in experimental studies. The objective of this study was to determine whether adrenaline was administered in accordance with advanced cardiac life support (ACLS) guidelines during adult cardiopulmonary resuscitation (CPR). METHODS: From 15 January to 31 December 2000, all patients at Uppsala University Hospital in whom CPR was attempted were registered prospectively. The duration of CPR was documented in the register and the total dose of adrenaline was retrieved retrospectively from patient records. From these data the average interval between adrenaline doses was calculated. RESULTS: Data for evaluation of the between-dose interval of adrenaline was available in 53 of 107 registered cardiac arrests. In 68% (36/53) the average between-dose interval was longer than the 3-5 min recommended in the guidelines, and 8% (4/53) received no adrenaline. The median interval between adrenaline doses during CPR was 6.5 min (25th-75th percentile: 5.1-10.4). Adherence to guidelines was lower in out-of-hospital cardiac arrest than in in-hospital cardiac arrest (P = 0.01). CONCLUSIONS: In the majority of cases adrenaline did not appear to be administered according to current ACLS guidelines.

Place, publisher, year, edition, pages
2004. Vol. 48, no 7, 909-913 p.
Keyword [en]
Adult, Aged, Aged; 80 and over, Cardiopulmonary Resuscitation, Epinephrine/*administration & dosage, Female, Humans, Male, Middle Aged, Practice Guidelines, Time Factors
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-91829DOI: 10.1111/j.1399-6576.2004.00440.xPubMedID: 15242439OAI: oai:DiVA.org:uu-91829DiVA: diva2:164686
Available from: 2004-05-07 Created: 2004-05-07 Last updated: 2013-06-19Bibliographically 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.
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1355
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
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
Available from: 2004-05-07 Created: 2004-05-07Bibliographically approved

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