Circulation, Vol 85, 281-287, Copyright © 1992 by American Heart Association
JT Niemann, CB Cairns, J Sharma and RJ Lewis
BACKGROUND. Early countershock of ventricular fibrillation has been shown
to improve immediate and long-term outcome of cardiac arrest. However, a
number of investigations in the laboratory and in the clinical population
indicate that immediate countershock of prolonged ventricular fibrillation
most commonly is followed by asystole or a nonperfusing spontaneous cardiac
rhythm, neither of which rarely respond to current therapy. The use of
epinephrine in doses greater than those currently recommended has recently
been shown to improve both cerebral and myocardial perfusion during
cardiopulmonary resuscitation (CPR). The purpose of this study was to
compare cardiac resuscitation outcome between immediate countershock of
prolonged ventricular fibrillation with high-dose epinephrine therapy and
conventional CPR before countershock of prolonged ventricular fibrillation
in a canine model. METHODS AND RESULTS. After sedation, intubation,
induction of anesthesia, and instrumentation, ventricular fibrillation was
electrically induced in 28 dogs. After 7.5 minutes of ventricular
fibrillation, animals were randomly allocated to two treatment groups:
group 1, immediate countershock followed by recommended advanced cardiac
life support (ACLS) interventions, or group 2, 0.08 mg/kg epinephrine and
manual closed-chest CPR before countershock and ACLS. In both groups, ACLS
was continued until a spontaneous perfusing rhythm was restored or for 20
minutes (total arrest time, 27.5 minutes). A spontaneous perfusing rhythm
was restored in three of 14 group 1 animals and in nine of 14 group 2
animals (p = 0.014 by sequential analysis method of Whitehead). Coronary
perfusion pressure (aortic minus right atrial pressure during CPR diastole)
before countershock was significantly greater in group 2 (21 +/- 7 mm Hg)
when compared with mean circulatory pressure in group 1 (9 +/- 8, p less
than 0.01). CONCLUSIONS. The findings of this study suggest that a brief
period of myocardial perfusion before countershock improves cardiac
resuscitation outcome from prolonged ventricular fibrillation.
ARTICLES
Treatment of prolonged ventricular fibrillation. Immediate countershock versus high-dose epinephrine and CPR preceding countershock
Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance 90509.
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