Levels of Catecholamines in the Plasma of Patients with Cardiopulmonary Arrest

Abstract

So far, there remains a controversy regarding the efficacy of epinephrine (Ep) in patients with cardiopulmonary arrest (CPA). In this study, we evaluated the importance of the plasma levels of catecholamines prior to the administration of Ep in patients with CPA. Patients with out-of-hospital cardiac arrest (OHCA) who were transferred to Gunma University Hospital were enrolled prospectively between July 2014 and July 2017. The levels of catecholamines [Ep, norepinephrine (NEp), and dopamine] and vasopressin (antidiuretic hormone) in the plasma were measured using blood samples of cardiogenic patients with OHCA not treated with Ep. Patients were divided into two groups: the return of spontaneous circulation [ROSC(+)] group and the no return of spontaneous circulation [ROSC(−)] group. The plasma levels of these agents and the conditions of resuscitation were compared between these two groups. 48 patients with cardiogenic CPA had not been treated with Ep prior to obtaining the blood samples. The ROSC(+) and ROSC(−) groups included 14 and 34 patients, respectively. The frequency of prehospital defibrillation was significantly higher in the ROSC(+) group. However, the prehospital resuscitation time was significantly shorter in the ROSC(+) group. Moreover, the levels of Ep and NEp in the plasma were significantly lower in the ROSC(+) group. The increased levels of Ep in the plasma may not be associated with the acquisition of ROSC in patients with cardiogenic CPA.

Relationship between the Plasma Levels of Catecholamines and Return of Spontaneous Circulation in Patients with Out-of-Hospital Cardiac Arrest

“…In the ROSC (+) group, the dosages of Ep and resuscitation time after arrival at the hospital were significantly lower and shorter, respectively. These results coincide with the findings of our previous report [ 12 ]. This suggests that the levels of endogenous Ep and Nep in the plasma before the administration of Ep are markedly increased in patients with OHCA, and those levels may not be related to the length of resuscitation time and the frequency of defibrillation.…”

“…Successful resuscitation, that is, ROSC (+), was defined as detection of a pulse at the carotid artery, femoral artery, or radial artery under advanced CPR and subsequent maintenance of systolic pressure ≥80 mmHg for 1 h with or without the continuous administration of vasoconstrictive agents intravenously or intraosseously [ 12 ]. Patients not achieving the above criteria were defined as ROSC (−).…”

Impact of Bystander Cardiopulmonary Resuscitation and Dispatcher Assistance on Survival After Out-of-Hospital Cardiac Arrest Among Adult Patients by Location of Arrest

“…However, the Japanese FDMA advises all medical-control authorities to prescribe CPR instruction protocols based on uniform DA recommendations. 15) Third, prior/concomitant medical history and estimated diagnosis as well as information about hospital care 36,37) after transfer to the emergency department of hospitals among OHCA patients were not included in the All-Japan Utstein registry of FDMA. Fourth, there might be unrecognized confounding factors affecting the association between bystander CPR implementation with or without DA, location of arrest, and survival outcome after OHCA.…”

Influence of the prehospital administered dosage of epinephrine on the plasma levels of catecholamines in patients with out-of-hospital cardiac arrest

“…Successful resuscitation, ROSC (+), was defined as detection of a pulse at the carotid artery, femoral artery, or radial artery under advanced CPR, and subsequent maintenance of systolic pressure ≥80 mmHg for 1 h with or without continuous administration of vasoconstrictive agents intravenously or intra-osseously [ 12 ]. Patients not achieving the above criteria were defined as ROSC (−).…”

“…evaluated the plasma Ep levels in patients with OHCA and showed that, prior to the administration of Ep, they were significantly lower in resuscitated patients than non-resuscitated patients [ 11 ]. In addition, we previously reported that the plasma Ep levels prior to the administration of Ep were significantly lower in the ROSC (+) group than the ROSC (−) group in patients with cardiogenic CPA [ 12 ].…”