Impact of catecholamines in cardiac arrest due to acute asphyxia--a study in piglets
Jacqueline Mauch1, Simone Ringer, Nelly Spielmann
1Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland; Department of Anesthesia and Perioperative Medicine, Kantonsspital Aarau, Tellstrasse, Aarau, Switzerland.
Insights
Intravenous and intramuscular epinephrine showed similar effects on plasma concentrations during asphyxial cardiac arrest (CA) resuscitation. High levels of endogenous epinephrine and norepinephrine predicted lower survival rates in this pediatric CA model.
Area of Science:
- Pediatric Resuscitation Science
- Cardiovascular Physiology
- Emergency Medicine Research
Background:
- Early intravenous epinephrine is crucial for return of spontaneous circulation in cardiac arrest (CA).
- Venous access is often difficult in pediatric patients, necessitating alternative routes.
- This study evaluated intravenous (IV) vs. intramuscular (IM) epinephrine in asphyxial CA.
Purpose of the Study:
- To compare the efficacy of IV and IM epinephrine administration in a pediatric asphyxial cardiac arrest model.
- To assess the impact of epinephrine route on survival and plasma concentrations.
- To identify predictors of survival in pediatric CA.
Main Methods:
- Twenty-eight piglets underwent asphyxial CA, followed by basic life support.
- Epinephrine was administered IV (10 μg·kg⁻¹) or IM (100 μg·kg⁻¹), with saline as a control.
- Survival and epinephrine plasma concentrations were measured throughout the resuscitation period.
Main Results:
- Intravenous epinephrine resulted in 100% survival, while IM epinephrine had 33% and saline 75% survival.
- Median epinephrine plasma concentration increase was significantly higher in IV and IM groups compared to saline.
- Higher baseline epinephrine and norepinephrine levels correlated with decreased survival.
Conclusions:
- Both IV and IM epinephrine increased plasma concentrations similarly during asphyxial CA resuscitation.
- Neither route demonstrated a significant hemodynamic or survival benefit over the other in this model.
- Elevated endogenous catecholamines are negative predictors for survival in pediatric CA.
Background:
Early intravenous epinephrine administration may help to achieve return of spontaneous circulation in cardiac arrest (CA). However, venous access can be challenging in small children. This study investigates the effect of intravenous and intramuscular epinephrine in treatment of asphyxial CA.
Methods:
Twenty-eight, 2-5-weeks-old, anesthetized piglets were asphyxiated by ventilation withdrawal. CA was untreated for 8 min, followed by 2 min of basic life support. Following this, epinephrine iv (10 μg·kg(-1) , group IV), epinephrine im (100 μg·kg(-1) , group IM), or normal saline (group NS) were administered. Further doses of epinephrine were given in group IV every 4 min, in group IM after 10 min if required. After twenty-two minutes of CA, iv epinephrine was given to all animals still in CA. Outcome measures were survival and epinephrine plasma concentrations.
Results:
Ten animals regained spontaneous circulation after 2 min of basic life support. Therefore, no drug treatment was administered (drop out). Resuscitation was effective in 2 pigs of group IM (n = 6), in 6 of group NS (n = 8) and in all of group IV (n = 4). Nonsurvivors had higher epinephrine (P < 0.01) and norepinephrine (P < 0.01) plasma concentrations prior to start of resuscitation. Median increase in epinephrine plasma concentration from T0 to T5 was 138, 134, and 29 nm in group IV, IM, and NS, respectively.
Conclusions:
Intravenous and intramuscular administered epinephrine led to similar increase in plasma concentrations during resuscitation of asphyxial CA without hemodynamic or survival benefit. High endogenous epinephrine and norepinephrine plasma concentrations were negative predictors for survival.
