Therapeutic and adverse effects of adrenaline on patients who suffer out-of-hospital cardiac arrest: a systematic review and meta-analysis

Zhong, Hong; Yin, Zhihua; Kou, Bojin; Shen, Pei Kang; He, Guowei; Huang, Tingting; Liang, Jing; Huang, Shan; Huang, Jiaming; Zhou, Manhong; Deng, Renli

doi:10.1186/s40001-022-00974-8

Cited by 3 publications

(1 citation statement)

References 48 publications

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“…Nevertheless, high vasopressor delivery can be detrimental to mechanical circulatory support such as ECMO due to the consequent increased afterload, which may impair systemic blood flow. Routine use of epinephrine during CPR may also lead to detrimental side effects such as increased myocardial work, inadequate regional blood flow due to increased microvascular vasoconstriction, reperfusion injury, and lactic acidosis (12)(13)(14)(15)(16)(17)(18)(19)(20). Taken together, these possible effects could lead to a need of further vasoactive use, increased mechanical support, and by progression an overall increased inflammatory response that may promote prolonged vasoconstriction.…”

mentioning

confidence: 99%

Epinephrine Dosing Use During Extracorporeal Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort*

Kucher

Márquez

Guerguerian

et al. 2023

Pediatric Critical Care Medicine

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Objectives: During pediatric cardiac arrest, contemporary guidelines recommend dosing epinephrine at regular intervals, including in patients requiring extracorporeal membrane oxygenation (ECMO). The impact of epinephrine-induced vasoconstriction on systemic afterload and venoarterial ECMO support is not well-defined. Design: Nested retrospective observational study within a single center. The primary exposure was time from last dose of epinephrine to initiation of ECMO flow; secondary exposures included cumulative epinephrine dose and arrest time. Systemic afterload was assessed by mean arterial pressure and use of systemic vasodilator therapy; ECMO pump flow and Vasoactive-Inotrope Score (VIS) were used as measures of ECMO support. Clearance of lactate was followed post-cannulation as a marker of systemic perfusion. Setting: PICU and cardiac ICU in a quaternary-care center. Patients: Patients 0–18 years old who required ECMO cannulation during resuscitation over the 6 years, 2014–2020. Patients were excluded if ECMO was initiated before cardiac arrest or if the resuscitation record was incomplete. Interventions: None. Measurements and Main Results: A total of 92 events in 87 patients, with 69 events having complete data for analysis. The median (interquartile range) of total epinephrine dosing was 65 mcg/kg (37–101 mcg/kg), with the last dose given 6 minutes (2–16 min) before the initiation of ECMO flows. Shorter interval between last epinephrine dose and ECMO initiation was associated with increased use of vasodilators within 6 hours of ECMO (p = 0.05), but not with mean arterial pressure after 1 hour of support (estimate, –0.34; p = 0.06). No other associations were identified between epinephrine delivery and mean arterial blood pressure, vasodilator use, pump speed, VIS, or lactate clearance. Conclusions: There is limited evidence to support the idea that regular dosing of epinephrine during cardiac arrest is associated with increased in afterload after ECMO cannulation. Additional studies are needed to validate findings against ECMO flows and clinically relevant outcomes.

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