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¿Está contraindicada la epinefrina durante la resucitación cardiopulmonar?
D N Thrush1, J B Downs, R A Smith
1Department of Anesthesiology, University of South Florida College of Medicine, Tampa 33612, USA.
Circulation
|November 14, 1997
Resumen
La epinefrina empeora el intercambio de gases pulmonares durante la resucitación cardiopulmonar (RCP) al aumentar la derivación intrapulmonar y reducir la saturación de oxígeno. La metoxamina ofrece efectos de presión similares sin estos efectos pulmonares adversos.
Área de la Ciencia:
- Fisiología cardiopulmonar Fisiología cardiopulmonar
- Farmacología Farmacología.
- Medicina de cuidados críticos Medicina de cuidados críticos.
Sus antecedentes:
- El deterioro del intercambio de gases pulmonares después de la administración de epinefrina durante la resucitación cardiopulmonar (RCP) no se comprende bien.
- El papel de la epinefrina en la alteración de la función pulmonar durante la reanimación requiere más investigación.
Objetivo del estudio:
- Investigar los efectos de la epinefrina en el intercambio de gases pulmonares durante la fibrilación ventricular experimental y la RCP.
- Para comparar los efectos de la epinefrina con la metoxamina, un agente presor que carece de actividad beta-adrenérgica, en el intercambio de gases durante la RCP.
Principales métodos:
- Los cerdos anestesiados se sometieron a fibrilación ventricular inducida y RCP.
- Se utilizó la infusión de gases inertes para determinar las distribuciones de ventilación-perfusión (VA/Q) a través de la técnica de eliminación múltiple de gases inertes.
- Las mediciones incluyeron el rendimiento cardíaco, la presión arterial, el pH y la saturación arterial de oxígeno después de la administración de solución salina, epinefrina o metoxamina.
Principales resultados:
- La fibrilación ventricular y la RCP disminuyeron significativamente el rendimiento cardíaco, la presión arterial y el pH.
- La administración de epinefrina condujo a un aumento significativo de la derivación intrapulmonar (aproximadamente un 300% más que la solución salina) y una reducción marcada de la saturación arterial de oxígeno (SaO2).
- La metoxamina aumentó la presión arterial diastólica de manera similar a la epinefrina, pero no empeoró la derivación intrapulmonar ni el SaO2.
Conclusiones:
- La epinefrina aumenta significativamente la derivación intrapulmonar y reduce la SaO2 durante la RCP, probablemente atenuando la vasoconstricción pulmonar hipóxica debido a su actividad beta-adrenérgica.
- La metoxamina es un agente presor eficaz para la RCP y no causa las anormalidades perjudiciales de intercambio de gases pulmonares observadas con la epinefrina.
- Se recomienda considerar la methoxamina o agentes similares en lugar de la epinefrina para la RCP para mejorar los resultados.
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