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(Circulation. 2000;101:e174.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Repeated Administration of Vasopressin but Not Epinephrine Maintains Coronary Perfusion Pressure After Early and Late Administration During Prolonged Cardiopulmonary Resuscitation in Pigs

Dr Michael Poullis

British Heart Foundation Cardiothoracic Research Fellow Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Hammersmith Hospital, London, UK

	Introduction

 
To the Editor:

Wenzel et al¹ provide additional evidence in favor of a change away from the use of epinephrine during cardiac arrest, which has been universally adopted due to the advanced cardiac life support guidelines. Unfortunately, the epinephrine doses of 45 and 200 µg/kg used in their study, which equate to 3.15 and 14 mg in a 70-kg patient, do not equate to those used clinically.

A side effect of epinephrine that is widely known but has not been discussed is the potent platelet aggregation that epinephrine induces.² Indeed, epinephrine is so good at producing platelet aggregation that it is widely used during platelet function tests as an aggregator³ (thus the importance of using equivalent doses of epinephrine to that used clinically).

We have demonstrated that an epinephrine dose of 1 mg in a 70-kg patient, which equates to 14.3 µg/kg, causes 10% platelet aggregation; however, the doses used in the study by Wenzel et al,¹ 45 and 200 µg/kg, cause 20% and 75% platelet aggregation, respectively. Thus, because they have not measured platelet aggregation, which could easily be done with the technique of microaggregation, the results of their study are confounded by a degree of platelet aggregation that is significant and that does not occur at the doses used clinically.

Cardiac arrest is mainly due to coronary thrombosis; therefore, administration of an agent that causes platelet aggregation has to be detrimental. An increased frequency of a polymorphism of the -receptor on platelets of patients with acute coronary syndromes . . . [Full Text of this Article]

Volker Wenzel, MD; Karl H. Lindner, MD; Anette C. Krismer, MD; Egfried A. Miller, MD; Wolfgang G. Voelckel, MD; Werner Lingnau, MD

Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria