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CRITICAL CARE AND TRAUMA

Epinephrine Increases Mortality after Brief Asphyxial Cardiac Arrest in an In Vivo Rat Model

Conán L. McCaul, MD^***, Patrick J. McNamara, MD^*, Doreen Engelberts^*, Gregory J. Wilson, MD^¶, Alex Romaschin, PhD^¶, Andrew N. Redington, MD^#, and Brian P. Kavanagh, MD^***

*The Lung Biology Program, The Research Institute, and the Departments of Critical Care Medicine, Anesthesia, Pediatrics (Neonatology and #Cardiology) and ¶Pathology, The Hospital for Sick Children; and the **Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario

Address correspondence and reprint requests to Brian P. Kavanagh, MD, Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada. Address e-mail to brian.kavanagh{at}sickkids.ca.

Epinephrine may be detrimental in cardiac arrest. In this laboratory study we sought to characterize the effect of epinephrine and concomitant calcium channel blockade on postresuscitation myocardial performance after brief asphyxial cardiac arrest. Anesthesized rats were disconnected from mechanical ventilation, resulting in cardiac arrest. Resuscitation was attempted after 1 min with mechanical ventilation, oxygen, chest compressions, and IV medication. In experimental series 1 and 2, animals were allocated to 10 or 30 µg/kg epinephrine or 0.9% saline. In series 3, animals received 30 µg/kg of epinephrine and were randomized to 0.1 mg/kg of verapamil or to 0.9% saline. In series 1 and 3, left ventricular function was assessed using transthoracic echocardiography. In series 2, left atrial pressure was measured. Epinephrine was associated with increased mortality (0/8 [0%] in controls, 4/12 [33.3%] in 10 µg/kg animals, and 16/22 [72.8%] in 30 µg/kg animals; P < 0.05), hypertension (P < 0.001), tachycardia (P = 0.004), early transient left atrial hypertension, and dose-related reduction in left ventricular end diastolic diameter (P < 0.05). Verapamil prevented mortality associated with large-dose epinephrine (0% versus 100%) and attenuated early diastolic dysfunction and postresuscitation hypertension (P = 0.001) without systolic dysfunction. Epinephrine appears to be harmful in the setting of brief cardiac arrest after asphyxia.

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