EFFECT OF STANDARD-DOSE VERSUS HIGH-DOSE EPINEPHRINE ON MYOCARDIAL HIGH-ENERGY PHOSPHATES DURING VENTRICULAR-FIBRILLATION AND CLOSED-CHEST CPR

被引：17
作者：
HOEKSTRA, JW
GRIFFITH, R
KELLEY, R
CODY, RJ
LEWIS, D
SCHEATZLE, M
BROWN, CG
机构：
[1] Department of Emergency Medicine The Ohio State University, Columbus
[2] Division of Cardiology, The Ohio State University, Columbus
来源：
ANNALS OF EMERGENCY MEDICINE | 1993年 / 22卷 / 09期
关键词：
adenosine triphosphate; cardiac arrest; epinephrine high-dose; phosphocreatine;
D O I：
10.1016/S0196-0644(05)81983-3
中图分类号：
R4 [临床医学];
学科分类号：
1002 ; 100602 ;
摘要：
Study objective: To evaluate the effects of standard-dose versus high-dose epinephrine on myocardial high-energy phosphate metabolism during resuscitation from cardiac arrest. Design: Prospective, nonrandomized, controlled study using a swine model of cardiac arrest and resuscitation. Interventions: After anesthesia, intravascular pressure instrumentation, and ten minutes of ventricular fibrillation arrest, closed-chest CPR was begun. After three minutes of CPR, animals were allocated to receive either 0.02 mg/kg IV standard-dose epinephrine (eight) or 0.2 mg/kg IV high-dose epinephrine (nine). The animals underwent thoracotomy and rapid-freezing transmural myocardial core biopsy for high-energy phosphate analysis 3.5 minutes after epinephrine administration. High-energy phosphate values were blindly determined using high-pressure liquid chromatography. Results: Intravascular pressure (mm Hg) and high-energy phosphate (nmol/mg protein) results for standard-dose epinephrine versus high-dose epinephrine are, respectively, coronary perfusion pressure, 1 5.3 +/- 7.8 versus 23.7 +/- 5.5 (P = .0009); phosphocreatine, 0.4 +/- 0.8 versus 6.2 +/- 4.4 (P = .0003); adenosine triphosphate, 9.8 +/- 4.8 versus 12.7 +/- 5.7 (P = .30); adenosine diphosphate, 5.4 +/- 2.1 versus 6.1 +/- 1.3 (P = .41); and adenylate charge, 0.68 +/- 0.12 versus 0.72 +/- 0.12 (P = .87). Conclusion: High-dose epinephrine does not deplete myocardial high-energy phosphate when given in this model of prolonged ventricular fibrillation. High-dose epinephrine increases coronary perfusion pressure compared with standard-dose epinephrine. High-dose epinephrine administration repletes phosphocreatine during closed-chest CPR, thereby increasing myocardial energy stores.
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收藏
页码：1385 / 1391
页数：7
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