| Does prearrest adrenergic integrity affect pressor response? A comparison of epinephrine and vasopressin in a spontaneous ventricular fibrillation swine model. | |
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MedLine Citation:
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PMID: 21051132 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Coronary perfusion pressure (CPP) during resuscitation from cardiac arrest has been shown to correlate with return of spontaneous circulation. Adrenergic blockade of beta-1 and alpha-1 receptors is common in the long-term management of ischemic heart disease and congestive heart failure. We sought to compare the CPP response to vasopressin vs. epinephrine in a swine model of cardiac arrest following pre-arrest adrenergic blockade. METHODS: Eight anesthetized and instrumented swine were administered 0.1mg epinephrine and arterial pressure and heart rate response were measured. An infusion of labetalol was then initiated and animals periodically challenged with epinephrine until adrenergic blockade was confirmed. The left anterior descending coronary artery was occluded to produce ventricular fibrillation (VF). After 7min of untreated VF, mechanical chest compressions were initiated. After 1min of compressions, 1mg epinephrine was given while CPP was recorded. When CPP values had returned to pre-epinephrine levels, 40U of bolus vasopressin was given. Differences in CPP (post-vasopressor-pre-vasopressor) were compared within animals for the epinephrine and vasopressin response and with eight, non-adrenergically blocked, historical controls using Bayesian statistics with a non-informative prior. RESULTS: The CPP response following epinephrine was 15.1mmHg lower in adrenergically blocked animals compared to non-adrenergically blocked animals (95% Highest Posterior Density [HPD] 2.9-27.2mmHg lower). CPP went up 18.4mmHg more following vasopressin when compared to epinephrine (95% HPD 8.2-29.1mmHg). The posterior probability of a higher CPP response from vasopressin (vs. epinephrine) in these animals was 0.999. CONCLUSIONS: Pre-arrest adrenergic blockade blunts the CPP response to epinephrine. Superior augmentation of CPP is attained with vasopressin under these conditions. |
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Authors:
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Scott T Youngquist; Atman Shah; Christian McClung; Joseph L Thomas; John P Rosborough; James T Niemann |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural Date: 2010-11-03 |
Journal Detail:
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Title: Resuscitation Volume: 82 ISSN: 1873-1570 ISO Abbreviation: Resuscitation Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-01-24 Completed Date: 2011-06-06 Revised Date: 2012-02-02 |
Medline Journal Info:
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Nlm Unique ID: 0332173 Medline TA: Resuscitation Country: Ireland |
Other Details:
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Languages: eng Pagination: 228-31 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Elsevier Ireland Ltd. All rights reserved. |
Affiliation:
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Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA. youngquist@hotmail.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic Antagonists
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pharmacology Animals Blood Pressure / drug effects* Coronary Circulation / drug effects* Disease Models, Animal Epinephrine / pharmacology* Heart Arrest / physiopathology* Heart Rate / drug effects* Male Swine Vasopressins / pharmacology* Ventricular Fibrillation / physiopathology |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL076671/HL/NHLBI NIH HHS; R01 HL076671-04/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic Antagonists; 11000-17-2/Vasopressins; 51-43-4/Epinephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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