Abstract 166: High Dose of Epinephrine Administered During Cardiopulmonary Resuscitation Leads to Greater Oxidative Stress Following Resuscitation From Cardiac Arrest
Introduction: Optimal dose of epinephrine to be used during CPR is controversial. Nevertheless, epinephrine has been recognized to increase ischemic injury. Oxidative stress that follows ROSC is another adverse event associated with cardiac resuscitation. We hypothesized that higher dose of epinephrine compared to the standard dose will cause greater systemic oxidative stress.
Methods: Ventricular fibrillation was induced in 12 SD rats, 430 ± 30 g, and untreated for 6 mins. CPR, including mechanical chest compression and ventilation, was then initiated and continued for 6 mins prior to defibrillations. Animals received i.v. injection of either a standard dose of epinephrine (20 μg/kg) or a higher dose of epinephrine (200 μg/kg), at 2 min after the start of CPR. Two hrs following ROSC, myocardial function was echocardiographically assessed. Animals were then sacrified and organs harvested for lipid hydroxides (LOOH) measurement, as markers of cell membrane lipid peroxidation and thereby of oxidative stress.
Results: No differences in coronary perfusion pressure (CPP) were observed between the two groups. All the animals treated with lower dose of epinephrine achieved ROSC while only 2 of 7 in the higher dose. Post ROSC myocardial function was greater in animals resuscitated after higher dose of epinephrine (table). LOOH in heart, brain, liver and kidney increased after resuscitation. However, after higher dose of epinephrine LOOH levels increased more than double compared to standard dose (Figure).
Conclusions: High dose of epinephrine compared to standard dose improved neither CPP nor ROSC, but it caused higher myocardial dysfunction and greater oxidative stress response.
- © 2010 by American Heart Association, Inc.