Reyhaneh Nosrati1,2, Steve Lin1,3,4,5, Rohit Mohindra6,7, Andrew Ramadeen3, Vladislav Toronov1, Paul Dorian3,4. 1. Department of Physics, Ryerson University, Toronto, ON, Canada. 2. Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada. 3. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 4. Department of Medicine, University of Toronto, Toronto, ON, Canada. 5. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 6. Jewish General Hospital Department of Emergency Medicine, 3755 Ch de la Côte-Sainte-Catherine, Montreal, QC, Canada. 7. Department of Critical Care Research, McGill University, Montreal, QC, Canada.
Abstract
OBJECTIVES: Epinephrine is routinely administered to sudden cardiac arrest patients during resuscitation, but the neurologic effects on patients treated with epinephrine are not well understood. This study aims to assess the cerebral oxygenation and metabolism during ventricular fibrillation cardiac arrest, cardiopulmonary resuscitation, and epinephrine administration. DESIGN: To investigate the effects of equal dosages of IV epinephrine administrated following sudden cardiac arrest as a continuous infusion or successive boluses during cardiopulmonary resuscitation, we monitored cerebral oxygenation and metabolism using hyperspectral near-infrared spectroscopy. SETTINGS: A randomized laboratory animal study. SUBJECTS: Nine healthy pigs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our study showed that although continuous epinephrine administration had no significant impact on overall cerebral hemodynamics, epinephrine boluses transiently improved cerebral oxygenation (oxygenated hemoglobin) and metabolism (cytochrome c oxidase) by 15% ± 6.7% and 49% ± 18%, respectively (p < 0.05) compared with the baseline (untreated) ventricular fibrillation. Our results suggest that the effects of epinephrine diminish with successive boluses as the impact of the third bolus on brain oxygen metabolism was 24.6% ± 3.8% less than that of the first two boluses. CONCLUSIONS: Epinephrine administration by bolus resulted in transient improvements in cerebral oxygenation and metabolism, whereas continuous epinephrine infusion did not, compared with placebo. Future studies are needed to evaluate and optimize the use of epinephrine in cardiac arrest resuscitation, particularly the dose, timing, and mode of administration.
OBJECTIVES:Epinephrine is routinely administered to sudden cardiac arrestpatients during resuscitation, but the neurologic effects on patients treated with epinephrine are not well understood. This study aims to assess the cerebral oxygenation and metabolism during ventricular fibrillation cardiac arrest, cardiopulmonary resuscitation, and epinephrine administration. DESIGN: To investigate the effects of equal dosages of IV epinephrine administrated following sudden cardiac arrest as a continuous infusion or successive boluses during cardiopulmonary resuscitation, we monitored cerebral oxygenation and metabolism using hyperspectral near-infrared spectroscopy. SETTINGS: A randomized laboratory animal study. SUBJECTS: Nine healthy pigs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our study showed that although continuous epinephrine administration had no significant impact on overall cerebral hemodynamics, epinephrine boluses transiently improved cerebral oxygenation (oxygenated hemoglobin) and metabolism (cytochrome c oxidase) by 15% ± 6.7% and 49% ± 18%, respectively (p < 0.05) compared with the baseline (untreated) ventricular fibrillation. Our results suggest that the effects of epinephrine diminish with successive boluses as the impact of the third bolus on brain oxygen metabolism was 24.6% ± 3.8% less than that of the first two boluses. CONCLUSIONS:Epinephrine administration by bolus resulted in transient improvements in cerebral oxygenation and metabolism, whereas continuous epinephrine infusion did not, compared with placebo. Future studies are needed to evaluate and optimize the use of epinephrine in cardiac arrest resuscitation, particularly the dose, timing, and mode of administration.
Authors: Jan Küchler; Stephan Klaus; Ludger Bahlmann; Nils Onken; Alexander Keck; Emma Smith; Jan Gliemroth; Claudia Ditz Journal: Eur J Trauma Emerg Surg Date: 2019-05-24 Impact factor: 3.693
Authors: Hyoung Youn Lee; Kamoljon Shamsiev; Najmiddin Mamadjonov; Yong Hun Jung; Kyung Woon Jeung; Jin Woong Kim; Tag Heo; Yong Il Min Journal: Int J Environ Res Public Health Date: 2021-05-31 Impact factor: 3.390
Authors: Julia C Slovis; Ryan W Morgan; William P Landis; Anna L Roberts; Alexandra M Marquez; Constantine D Mavroudis; Yuxi Lin; Tiffany Ko; Vinay M Nadkarni; Robert A Berg; Robert M Sutton; Todd J Kilbaugh Journal: Resusc Plus Date: 2020-11-25
Authors: Constantine D Mavroudis; Tiffany S Ko; Ryan W Morgan; Lindsay E Volk; William P Landis; Benjamin Smood; Rui Xiao; Marco Hefti; Timothy W Boorady; Alexandra Marquez; Michael Karlsson; Daniel J Licht; Vinay M Nadkarni; Robert A Berg; Robert M Sutton; Todd J Kilbaugh Journal: Crit Care Date: 2020-09-29 Impact factor: 9.097