Cardiovascular response to epinephrine varies with increasing duration of cardiac arrest

Impact of Early Intravenous Epinephrine Administration on Outcomes Following Out-of-Hospital Cardiac Arrest

“…26-28 Another animal study indicates that the cardiovascular response to epinephrine varies with the increasing duration of cardiac arrest, and myocardial depression subsequently develops. 29 These can be possible explanations for the positive results in those with early epinephrine administration and the negative result for overall survival of this study. Although this is the first study to suggest the benefit of early epinephrine administration for OHCA in humans, it is clinically very difficult to administer epinephrine in this early period and the number of OHCA patients who received intravenous epinephrine within 10 min after OHCA occurrence was small.…”

Anesthetic Management of a Patient with Deteriorated Cardiac Function Following Cardiopulmonary Resuscitation

“…On the other hand, catecholamine-induced myocardial stunning can be caused by a surge in blood concentrations of catecholamines in association with the induction of β-adrenoreceptor (β-AR). Catecholamines such as epinephrine, dopamine and dobutamine, especially in high doses, may increase myocardial oxygen consumption, resulting in an imbalance between myocardial oxygen supply and demand, which can produce myocardial stunning [2][3][4][5][6][7][8]. In our case, continuous infusion of high-dose dopamine had been initiated immediately following epinephrine administration for CPR, suggesting that these catecholamines might have exacerbated cardiac dysfunction in the post-resuscitation period.…”

“…The effects of surged catecholamine levels on myocardial stunning and the induction of β-AR are reversible after catecholamine levels return to normal [8,9]. Some investigators have reported that blockade of β-AR significantly improves the initial outcomes of CPR, minimizes post-resuscitation myocardial dysfunction, and increases the duration of survival [7,[10][11][12]. Although no β-AR blocking agents were administered in our case, stable cardiac function was obtained by reducing the infusion rate of dopamine while transfusing adequate volumes of blood products.…”

Efeitos hemodinâmicos e metabólicos da terlipressina ou naloxona na ressuscitação cardiopulmonar: estudo experimental, randomizado e controlado

“…(7,8). Apesar disso, há evidências de que a epinefrina eleva o consumo de oxigênio, reduz a pressão de perfusão subendocárdica(9) e causa grave disfunção ou lesão do miocárdio no período após o RCE (10)(11)(12)(13)(14)(15)(16)(17).…”

“…A epinefrina é o vasopressor recomendado e mais utilizado nesta situação (75), embora existam evidências de que a droga tenha consequências indesejáveis e adversas para o sistema cardiovascular (9)(10)(11)(12)(13)(14)(15)(16)(17). Adicionalmente, evidências recentes sugerem que a epinefrina piora a perfusão da microcirculação cerebral, aumentando a gravidade da isquemia do SNC durante a RCP (18)(19)(20).…”