Epinephrine's effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

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

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Background: Despite controversies, epinephrine remains a mainstay of cardiopulmonary resuscitation (CPR). Recent animal studies have suggested that epinephrine may decrease cerebral blood flow (CBF) and cerebral oxygenation, possibly potentiating neurological injury during CPR. We investigated the cerebrovascular effects of intravenous epinephrine in a swine model of pediatric in-hospital cardiac arrest. The primary objectives of this study were to determine if (1) epinephrine doses have a significant acute effect on CBF and cerebral tissue oxygenation during CPR and (2) if the effect of each subsequent dose of epinephrine differs significantly from that of the first. Methods: One-month-old piglets (n = 20) underwent asphyxia for 7 min, ventricular fibrillation, and CPR for 10-20 min. Epinephrine (20 mcg/kg) was administered at 2, 6, 10, 14, and 18 min of CPR. Invasive (laser Doppler, brain tissue oxygen tension [PbtO2]) and noninvasive (diffuse correlation spectroscopy and diffuse optical spectroscopy) measurements of CBF and cerebral tissue oxygenation were simultaneously recorded. Effects of subsequent epinephrine doses were compared to the first. Results: With the first epinephrine dose during CPR, CBF and cerebral tissue oxygenation increased by > 10%, as measured by each of the invasive and noninvasive measures (p < 0.001). The effects of epinephrine on CBF and cerebral tissue oxygenation decreased with subsequent doses. By the fifth dose of epinephrine, there were no demonstrable increases in CBF of cerebral tissue oxygenation. Invasive and noninvasive CBF measurements were highly correlated during asphyxia (slope effect 1.3, p < 0.001) and CPR (slope effect 0.20, p < 0.001). Conclusions: This model suggests that epinephrine increases CBF and cerebral tissue oxygenation, but that effects wane following the third dose. Noninvasive measurements of neurological health parameters hold promise for developing and directing resuscitation strategies.

Original languageEnglish (US)
Article number583
JournalCritical Care
Volume24
Issue number1
DOIs
StatePublished - Sep 29 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 The Author(s).

Keywords

  • Cardiopulmonary resuscitation
  • Cerebral blood flow
  • Cerebral blood flow and metabolism
  • Diffuse correlation spectroscopy
  • Diffuse optical spectroscopy

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