Circulation, Vol 69, 822-835, Copyright © 1984 by American Heart Association
JR Michael, AD Guerci, RC Koehler, AY Shi, J Tsitlik, N Chandra, E Niedermeyer, MC Rogers, RJ Traystman and ML Weisfeldt
The goals of this study were to quantify the effects of epinephrine on
myocardial and cerebral blood flow during conventional cardiopulmonary
resuscitation (CPR) and CPR with simultaneous chest compression-
ventilation and to test the hypothesis that epinephrine would improve
myocardial and cerebral blood flow by preventing collapse of intrathoracic
arteries and by vasoconstricting other vascular beds, thereby increasing
perfusion pressures. Cerebral and myocardial blood flow were measured by
the radiolabeled microsphere technique, which we have previously validated
during CPR. We studied the effect of epinephrine on established arterial
collapse during CPR with simultaneous chest compression-ventilation with
the abdomen bound or unbound. Epinephrine reversed arterial collapse,
thereby eliminating the systolic gradient between aortic and carotid
pressures and increasing cerebral perfusion pressure and cerebral blood
flow while decreasing blood flow to other cephalic tissues. Epinephrine
produced higher cerebral and myocardial perfusion pressures during CPR with
simultaneous chest compression-ventilation when the abdomen was unbound
rather than bound because abdominal binding increased intracranial and
venous pressures. In other experiments we compared the effect of
epinephrine on blood flow during 1 hr of either conventional CPR or with
simultaneous chest compression-ventilation with the abdomen unbound.
Epinephrine infusion during conventional CPR produced an average cerebral
blood flow of 15 ml/min . 100 g (41 +/- 15% of control) and an average
myocardial blood flow of 18 ml/min . 100 g (15 +/- 8% of control). In our
previous studies, cerebral and myocardial blood flow were less than 3 +/-
1% of control during conventional CPR without epinephrine. Although flows
during CPR with simultaneous chest compression-ventilation without
epinephrine were initially higher than those during conventional CPR,
arterial collapse developed after 20 min, limiting cerebral and myocardial
blood flow. The use of epinephrine throughout 50 min of CPR with
simultaneous chest compression-ventilation maintained cerebral blood flow
at 22 +/- 2 ml/min . 100 g (73 +/- 25% control) and left ventricular blood
flow at 38 +/- 9 ml/min . 100 g (28 +/- 8% control). The improved blood
flows with epinephrine correlated with improved electroencephalographic
activity and restoration of spontaneous circulation.(ABSTRACT TRUNCATED AT
400 WORDS)
ARTICLES
Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs
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