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Adverse effects of high-dose epinephrine on cerebral blood flow 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 Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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2000 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 28, no 5, 1423-1430 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To study the effects of high-dose epinephrine, compared with standard-dose epinephrine, on the dynamics of superficial cortical cerebral blood flow as well as global cerebral oxygenation during experimental cardiopulmonary resuscitation. We hypothesized that high-dose epinephrine might be unable to improve cerebral blood flow during cardiopulmonary resuscitation as compared with standard-dose epinephrine.

DESIGN:

Randomized controlled study.

SETTING:

University hospital research laboratory.

SUBJECTS:

A total of 20 male anesthetized piglets.

INTERVENTIONS:

Ventricular fibrillation was induced. A nonintervention interval of 8 mins was followed by open-chest cardiopulmonary resuscitation. The animals were randomized to receive repeated bolus injections of either 20 microg/kg (standard-dose group, n = 10) or 200 microg/kg (high-dose group, n = 10) of epinephrine.

MEASUREMENTS AND MAIN RESULTS:

Focal cortical cerebral blood flow was measured continuously by using laser Doppler flowmetry. The duration of blood flow increase was significantly shorter in the high-dose group after the second dose of epinephrine. In the high-dose group there was also a consistent tendency for lower peak levels and shorter duration of flow increase in response to repeated bolus doses of epinephrine. Cerebral oxygen extraction ratio was significantly lower in the high-dose group after administration of epinephrine.

CONCLUSIONS:

Repeated bolus doses of epinephrine 200 microg/kg, as compared with 20 microg/kg, do not improve superficial cortical cerebral blood flow during experimental open-chest cardiopulmonary resuscitation. High-dose epinephrine appears to induce vasoconstriction of cortical cerebral blood vessels resulting in redistribution of blood flow from superficial cortex. This might be one explanation for the failure of high-dose epinephrine to improve overall outcome in clinical trials.

Place, publisher, year, edition, pages
2000. Vol. 28, no 5, 1423-1430 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-254385PubMedID: 10834690OAI: oai:DiVA.org:uu-254385DiVA: diva2:818087
Available from: 2015-06-08 Created: 2015-06-08 Last updated: 2017-12-04Bibliographically approved

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Gedeborg, RolfRonne-Engström, ElisabethRubertsson, StenWiklund, Lars

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