Does prearrest adrenergic integrity affect pressor response? A comparison of epinephrine and vasopressin in a spontaneous ventricular fibrillation swine model
Does prearrest adrenergic integrity affect pressor response? A comparison of epinephrine and vasopressin in a spontaneous ventricular fibrillation swine model
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DOI：
10.1016/j.resuscitation.2010.10.004
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发表时间：
2011-02-01
期刊：
影响因子：
6.5
通讯作者：
Niemann, James T.
中科院分区：
文献类型：
--
作者：
Youngquist, Scott T.;Shah, Atman;Niemann, James T.
目的：心脏骤停复苏期间的冠状动脉灌注压（CPP）已被证明与自然循环的恢复相关。肾上腺素能阻断β -1和α -1受体在缺血性心脏病和充血性心力衰竭的长期治疗中很常见。在猪心脏骤停模型中，我们试图比较抗利尿激素和肾上腺素对CPP的反应。方法：8头麻醉和器械化猪注射0.1 mg肾上腺素，测定其动脉压和心率反应。然后开始输注拉贝他洛尔，并定期给动物注射肾上腺素，直到确认肾上腺素能阻断。左冠状动脉前降支闭塞导致心室颤动（VF）。未经治疗的VF 7分钟后，开始机械胸外按压。按压1 min后，给予肾上腺素1 mg，同时记录CPP。当CPP值恢复到肾上腺素分泌前水平时，给予40U后叶加压素。利用贝叶斯统计和非信息性先验比较动物肾上腺素和抗利尿激素反应的CPP（加压后-加压前）差异，并与8个非肾上腺素能阻断的历史对照进行比较。结果：肾上腺素阻断动物的CPP反应比非肾上腺素阻断动物低15.1 mmHg（95%最高后密度[HPD]低2.9-27.2 mmHg）。与肾上腺素相比，加压素后CPP升高18.4 mmHg （95% HPD 8.2-29.1 mmHg）。在这些动物中，抗利尿激素（相对于肾上腺素）产生更高CPP反应的后验概率为0.999。结论：停搏前肾上腺素能阻断可减弱CPP对肾上腺素的反应。在这些条件下，抗利尿激素可显著提高CPP。2010爱思唯尔爱尔兰有限公司版权所有。
Objectives: Coronary perfusion pressure (CPP) during resuscitation from cardiac arrest has been shown to correlate with return of spontaneous circulation. Adrenergic blockade of beta-1 and alpha-1 receptors is common in the long-term management of ischemic heart disease and congestive heart failure. We sought to compare the CPP response to vasopressin vs. epinephrine in a swine model of cardiac arrest following pre-arrest adrenergic blockade.Methods: Eight anesthetized and instrumented swine were administered 0.1 mg epinephrine and arterial pressure and heart rate response were measured. An infusion of labetalol was then initiated and animals periodically challenged with epinephrine until adrenergic blockade was confirmed. The left anterior descending coronary artery was occluded to produce ventricular fibrillation (VF). After 7 min of untreated VF, mechanical chest compressions were initiated. After 1 min of compressions, 1 mg epinephrine was given while CPP was recorded. When CPP values had returned to pre-epinephrine levels, 40U of bolus vasopressin was given. Differences in CPP (post-vasopressor-pre-vasopressor) were compared within animals for the epinephrine and vasopressin response and with eight, non-adrenergically blocked, historical controls using Bayesian statistics with a non-informative prior.Results: The CPP response following epinephrine was 15.1 mmHg lower in adrenergically blocked animals compared to non-adrenergically blocked animals (95% Highest Posterior Density [HPD] 2.9-27.2 mmHg lower). CPP went up 18.4 mmHg more following vasopressin when compared to epinephrine (95% HPD 8.2-29.1 mmHg). The posterior probability of a higher CPP response from vasopressin (vs. epinephrine) in these animals was 0.999.Conclusions: Pre-arrest adrenergic blockade blunts the CPP response to epinephrine. Superior augmentation of CPP is attained with vasopressin under these conditions. (C) 2010 Elsevier Ireland Ltd. All rights reserved.