(Circulation. 1995;92:3089-3093.)
© 1995 American Heart Association, Inc.
Articles |
Epinephrine Increases the Severity of Postresuscitation Myocardial Dysfunction
From the Institute of Critical Care Medicine, Palm Springs, Calif.
Correspondence to Max Harry Weil, MD, PhD, Institute of Critical Care Medicine, 1695 North Sunrise Way, Palm Springs, CA 92262.
Background Epinephrine has been the mainstay for
cardiac resuscitation for more than 30 years. Its vasopressor effect by
which it increases coronary perfusion pressure is likely to
favor initial resuscitation. Its ß-adrenergic action, however,
may have detrimental effects on postresuscitation myocardial function
when administered before resuscitation because it increases myocardial
oxygen consumption. In the present study, our focus was on
postresuscitation effects of epinephrine when this adrenergic
agent was administered during cardiopulmonary
resuscitation. Postresuscitation myocardial functions were compared
with those of a selective 
-adrenergic agent,
phenylephrine, when epinephrine was combined with a
ß1-adrenergic blocking agent, esmolol, and saline
placebo.
Methods and Results Ventricular fibrillation was
induced in 40 Sprague-Dawley rats. Mechanical ventilation and
precordial compression was initiated either 4 or 8 minutes
after the start of ventricular fibrillation. The adrenergic
drug or saline placebo was administered as a bolus after 4 minutes of
precordial compression. Defibrillation was attempted 4 minutes
later. Left ventricular pressure,
dP/dt40, and negative dP/dt were continuously
measured for an interval of 240 minutes after successful cardiac
resuscitation. Except for saline placebo, comparable increases in
coronary perfusion pressure were observed after each drug
intervention. The number of countershocks required for restoration of
spontaneous circulation was significantly greater for
epinephrine-treated animals (10±8) when compared with
phenylephrine-treated animals (1.8±0.4,
P<.01) and with animals treated with epinephrine
combined with esmolol (1.6±0.9, P<.01). After
resuscitation, dP/dt40 and negative dP/dt were
significantly decreased and left ventricular
end-diastolic pressure was significantly increased in
each animal when compared with prearrest levels. However, the greatest
impairment followed epinephrine, and this was associated with
significantly greater heart rate and the shortest interval of
postresuscitation survival of 8±4 hours, whereas placebo controls
survived for 12±11 hours. Phenylephrine-treated
animals survived for 41±10 hours (P<.01 versus
epinephrine), and animals that received a combination of
epinephrine and esmolol survived for 35±11 hours
(P<.01 versus epinephrine). When the duration of
untreated cardiac arrest was increased from 4 to 8 minutes, the
severity of postresuscitation left ventricular dysfunction
was magnified, but disproportionate decreases in postresuscitation
survival were again observed with placebo and epinephrine when
compared with -adrenergic agonists.
Conclusions In an established rodent model after resuscitation
following cardiac arrest, epinephrine significantly increased
the severity of postresuscitation myocardial dysfunction and decreased
duration of survival. More selective -adrenergic agonist or
blockade of ß1-adrenergic actions of epinephrine
reduced postresuscitation myocardial impairment and prolonged
survival.
Key Words: myocardium • cardiopulmonary resuscitation
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