Dose-dependent vasopressor response to epinephrine during CPR in human beings

Gonzalez, Edgar R.; Ornato, Joseph P.; Garnett, A Randolph; Levine, Roger; Young, Denise S; Racht, Edward M.

doi:10.1016/s0196-0644(89)80453-6

Cited by 138 publications

(23 citation statements)

References 42 publications

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“…These closely approximate aortic relaxation pressures during CPR in humans. 211,221 The same study that identified a CPP threshold of Ն15 mm Hg for ROSC also reported that ROSC was not achieved if aortic relaxation "diastolic" pressure did not exceed 17 mm Hg during CPR. 168 A specific target arterial relaxation pressure that optimizes the chance of ROSC has not been established.…”

Section: Coronary Perfusion Pressure and Arterialmentioning

confidence: 97%

“…209,210 The correlation of PETCO 2 with CPP during CPR can be altered by vasopressor therapy, especially at high doses (ie, Ͼ1 mg of epinephrine). [211][212][213][214] Vasopressors cause increased afterload, which will increase blood pressure and myocardial blood flow during CPR but will also decrease cardiac output. Therefore, a small decrease in PETCO 2 after vasopressor therapy may occur but should not be misinterpreted as a decrease in CPR quality.…”

Section: Pulsementioning

confidence: 99%

See 1 more Smart Citation

Part 8: Adult Advanced Cardiovascular Life Support

Neumar¹,

Otto²,

Link³

et al. 2010

Circulation

1,348

872

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Section: Coronary Perfusion Pressure and Arterialmentioning

confidence: 97%

Section: Pulsementioning

confidence: 99%

Part 8: Adult Advanced Cardiovascular Life Support

Neumar¹,

Otto²,

Link³

et al. 2010

Circulation

1,348

872

View full text Add to dashboard Cite

“…Coronary perfusion pressure (CPP) is a predictor of return of spontaneous circulation (ROSC) in human adults [21], and therapies that improve CPP, including adrenaline [22], increase the probability of ROSC [21]. …”

Section: Resultsmentioning

confidence: 99%

Evidence on Adrenaline Use in Resuscitation and Its Relevance to Newborn Infants: A Non-Systematic Review

et al. 2016

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Aim: Guidelines for newborn resuscitation state that if the heart rate does not increase despite adequate ventilation and chest compressions, adrenaline administration should be considered. However, controversy exists around the safety and effectiveness of adrenaline in newborn resuscitation. The aim of this review was to summarise a selection of the current knowledge about adrenaline during resuscitation and evaluate its relevance to newborn infants. Methods: A search in PubMed, Embase, and Google Scholar until September 1, 2015, using search terms including adrenaline/epinephrine, cardiopulmonary resuscitation, death, severe brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and adrenaline versus vasopressin/placebo. Results: Adult data indicate that adrenaline improves the return of spontaneous circulation (ROSC) but not survival to hospital discharge. Newborn animal studies reported that adrenaline might be needed to achieve ROSC. Intravenous administration (10-30 μg/kg) is recommended; however, if there is no intravenous access, a higher endotracheal dose (50-100 μg/kg) is needed. The safety and effectiveness of intraosseous adrenaline remain undetermined. Early and frequent dosing does not seem to be beneficial. In fact, negative hemodynamic effects have been observed, especially with doses ≥30 μg/kg intravenously. Little is known about adrenaline in birth asphyxia and in preterm infants, but observations indicate that hemodynamics and neurological outcomes may be impaired by adrenaline administration in these conditions. However, a causal relationship between adrenaline administration and outcomes cannot be established from the few available retrospective studies. Alternative vasoconstrictors have been investigated, but the evidence is scarce. Conclusion: More research is needed on the benefits and risks of adrenaline in asphyxia-induced bradycardia or cardiac arrest during perinatal transition.

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“…More recently, concern was raised that due to the difference in mass between the dogs used in the study and an adult human, the dose of adrenaline used in the study was too small. Additionally, it was shown that at doses above 1mg, a dose-dependent vasopressor relationship existed to adrenaline in human beings during CPR (Gonzalez et al 1989). In other words, at 1mg the dose was submaximal.…”

Section: High-dose Adrenalinementioning

confidence: 99%