Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest
Adrenaline is recommended for cardiac arrest resuscitation, but its effectiveness has been questioned recently. Achieving return of spontaneous circulation (ROSC) is essential and is obtained by increasing coronary perfusion pressure (CPP) after adrenaline injection. A threshold as high as 35 mmHg o...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/20/4674 |
| _version_ | 1797514220366987264 |
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| author | Deborah Jaeger Jonathan Koger Helene Duhem Caroline Fritz Victor Jeangeorges Kevin Duarte Bruno Levy Guillaume Debaty Tahar Chouihed |
| author_facet | Deborah Jaeger Jonathan Koger Helene Duhem Caroline Fritz Victor Jeangeorges Kevin Duarte Bruno Levy Guillaume Debaty Tahar Chouihed |
| author_sort | Deborah Jaeger |
| collection | DOAJ |
| description | Adrenaline is recommended for cardiac arrest resuscitation, but its effectiveness has been questioned recently. Achieving return of spontaneous circulation (ROSC) is essential and is obtained by increasing coronary perfusion pressure (CPP) after adrenaline injection. A threshold as high as 35 mmHg of CPP may be necessary to obtain ROSC, but increasing doses of adrenaline might be harmful to the brain. Our study aimed to compare the increase in CPP with reduced doses of adrenaline to the recommended 1 mg dose in a pig model of cardiac arrest. Fifteen domestic pigs were randomized into three groups according to the adrenaline doses: 1 mg, 0.5 mg, or 0.25 mg administered every 5 min. Cardiac arrest was induced by ventricular fibrillation; after 5 min of no-flow, mechanical chest compression was resumed. The Wilcoxon test and Kruskal–Wallis exact test were used for the comparison of groups. Fisher’s exact test was used to compare categorical variables. CPP, EtCO<sub>2</sub> level, cerebral, and tissue near-infrared spectroscopy (NIRS) were measured. CPP was significantly lower in the 0.25 mg group 90 s after the first adrenaline injection: 28.9 (21.2; 35.4) vs. 53.8 (37.8; 58.2) in the 1 mg group (<i>p</i> = 0.008), while there was no significant difference with 0.5 mg 39.6 (32.7; 52.5) (<i>p</i> = 0.056). Overall, 0.25 mg did not achieve the threshold of 35 mmHg. EtCO<sub>2</sub> levels were higher at T12 and T14 in the 0.5 mg than in the standard group: 32 (23; 35) vs. 19 (16; 26) and 26 (20; 34) vs. 19 (12; 22) (<i>p</i> < 0.05). Cerebral and tissue NIRS did not show a significant difference between the three groups. CPP after 0.5 mg boluses of adrenaline was not significantly different from the recommended 1 mg in our model of cardiac arrest. |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T06:28:32Z |
| publishDate | 2021-10-01 |
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| spelling | doaj.art-1382181b601249c3805ab3ee8de18d3d2023-11-22T18:41:22ZengMDPI AGJournal of Clinical Medicine2077-03832021-10-011020467410.3390/jcm10204674Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac ArrestDeborah Jaeger0Jonathan Koger1Helene Duhem2Caroline Fritz3Victor Jeangeorges4Kevin Duarte5Bruno Levy6Guillaume Debaty7Tahar Chouihed8SAMU-SMUR, Service d’Urgences, CHRU Nancy, 54000 Nancy, FranceSAMU-SMUR, Service d’Urgences, CHRU Nancy, 54000 Nancy, FranceService d’Urgences, Université de Grenoble Alpes/CNRS/CHU de Grenoble Alpes, 38000 Grenoble, FranceINSERM, Université de Lorraine, 54000 Nancy, FranceSAMU-SMUR, Service d’Urgences, CHRU Nancy, 54000 Nancy, FranceCentre d’Investigation Clinique Plurithématique, INSERM, Université de Lorraine, 54000 Nancy, FranceINSERM, Université de Lorraine, 54000 Nancy, FranceService d’Urgences, Université de Grenoble Alpes/CNRS/CHU de Grenoble Alpes, 38000 Grenoble, FranceSAMU-SMUR, Service d’Urgences, CHRU Nancy, 54000 Nancy, FranceAdrenaline is recommended for cardiac arrest resuscitation, but its effectiveness has been questioned recently. Achieving return of spontaneous circulation (ROSC) is essential and is obtained by increasing coronary perfusion pressure (CPP) after adrenaline injection. A threshold as high as 35 mmHg of CPP may be necessary to obtain ROSC, but increasing doses of adrenaline might be harmful to the brain. Our study aimed to compare the increase in CPP with reduced doses of adrenaline to the recommended 1 mg dose in a pig model of cardiac arrest. Fifteen domestic pigs were randomized into three groups according to the adrenaline doses: 1 mg, 0.5 mg, or 0.25 mg administered every 5 min. Cardiac arrest was induced by ventricular fibrillation; after 5 min of no-flow, mechanical chest compression was resumed. The Wilcoxon test and Kruskal–Wallis exact test were used for the comparison of groups. Fisher’s exact test was used to compare categorical variables. CPP, EtCO<sub>2</sub> level, cerebral, and tissue near-infrared spectroscopy (NIRS) were measured. CPP was significantly lower in the 0.25 mg group 90 s after the first adrenaline injection: 28.9 (21.2; 35.4) vs. 53.8 (37.8; 58.2) in the 1 mg group (<i>p</i> = 0.008), while there was no significant difference with 0.5 mg 39.6 (32.7; 52.5) (<i>p</i> = 0.056). Overall, 0.25 mg did not achieve the threshold of 35 mmHg. EtCO<sub>2</sub> levels were higher at T12 and T14 in the 0.5 mg than in the standard group: 32 (23; 35) vs. 19 (16; 26) and 26 (20; 34) vs. 19 (12; 22) (<i>p</i> < 0.05). Cerebral and tissue NIRS did not show a significant difference between the three groups. CPP after 0.5 mg boluses of adrenaline was not significantly different from the recommended 1 mg in our model of cardiac arrest.https://www.mdpi.com/2077-0383/10/20/4674cardiac arrestadrenalinecoronary perfusion pressureresuscitation |
| spellingShingle | Deborah Jaeger Jonathan Koger Helene Duhem Caroline Fritz Victor Jeangeorges Kevin Duarte Bruno Levy Guillaume Debaty Tahar Chouihed Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest Journal of Clinical Medicine cardiac arrest adrenaline coronary perfusion pressure resuscitation |
| title | Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest |
| title_full | Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest |
| title_fullStr | Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest |
| title_full_unstemmed | Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest |
| title_short | Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest |
| title_sort | mildly reduced doses of adrenaline do not affect key hemodynamic parameters during cardio pulmonary resuscitation in a pig model of cardiac arrest |
| topic | cardiac arrest adrenaline coronary perfusion pressure resuscitation |
| url | https://www.mdpi.com/2077-0383/10/20/4674 |
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