This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hilwig, R. W. Articles by Ewy, G. A. Search for Related Content PubMed PubMed Citation Articles by Hilwig, R. W. Articles by Ewy, G. A. Related Collections Cardiovascular Pharmacology Animal models of human disease CPR and emergency cardiac care Other Vascular biology

(Circulation. 2000;101:2097.)
© 2000 American Heart Association, Inc.

Basic Science Reports

Endothelin-1 Vasoconstriction During Swine Cardiopulmonary Resuscitation Improves Coronary Perfusion Pressures but Worsens Postresuscitation Outcome

Ronald W. Hilwig, DVM, PhD; Robert A. Berg, MD; Karl B. Kern, MD; Gordon A. Ewy, MD

From the University of Arizona Department of Medicine (R.W.H., K.B.K., G.A.E.), the University of Arizona Sarver Heart Center (R.W.H., R.A.B., K.B.K., G.A.E.), the Department of Pediatrics, Steele Memorial Children’s Research Center (R.A.B.), and the University of Arizona College of Medicine, Tucson.

Background—Vasoconstriction during cardiopulmonary resuscitation (CPR) improves coronary perfusion pressure (CPP) and thereby outcome. The combination of endothelin-1 (ET-1) plus epinephrine improved CPP during CPR compared with epinephrine alone in a canine cardiac arrest model. The effect of the combination on outcome variables, such as successful resuscitation and survival, has not been investigated.

Methods and Results—Twenty-seven swine were randomly provided with 1 mg epinephrine (Epi group) or 1 mg epinephrine plus 0.1 mg ET-1 (ET-1 group) during a prolonged ventricular fibrillatory cardiac arrest. ET-1 resulted in substantially superior aortic relaxation pressure and CPP during CPR. These hemodynamic improvements tended to increase initial rates of restoration of spontaneous circulation (8 of 10 versus 8 of 17, P=0.12). However, continued intense vasoconstriction from ET-1 led to higher aortic diastolic pressure and very narrow pulse pressure after resuscitation. The mean pulse pressure 1 hour after resuscitation was 7±8 mm Hg with ET-1 versus 24±1 mm Hg with Epi, P<0.01. Most importantly, the postresuscitation mortality was dramatically higher in the ET-1 group (6 of 8 versus 0 of 8 in the Epi group, P<0.01).

Conclusions—These data establish that administration of ET-1 during CPR can result in worse postresuscitation outcome. The intense vasoconstriction from ET-1 improved CPP during CPR but had detrimental effects in the postresuscitation period.

Key Words: endothelin • heart arrest • cardiopulmonary resuscitation • catecholamines • survival

This article has been cited by other articles:

				Part 4: Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-25 - III-54. [Full Text] [PDF]

				A. A. El-Menyar The Resuscitation Outcome: Revisit the Story of the Stony Heart Chest, October 1, 2005; 128(4): 2835 - 2846. [Abstract] [Full Text] [PDF]

				K. H. Stadlbauer, H. G. Wagner-Berger, V. Wenzel, W. G. Voelckel, A. C. Krismer, G. Klima, K. Rheinberger, S. Pechlaner, V. D. Mayr, and K. H. Lindner Survival with Full Neurologic Recovery After Prolonged Cardiopulmonary Resuscitation with a Combination of Vasopressin and Epinephrine in Pigs Anesth. Analg., June 1, 2003; 96(6): 1743 - 1749. [Abstract] [Full Text] [PDF]