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A randomized, blinded trial of high-dose epinephrine versus standard-dose epinephrine in a swine model of pediatric asphyxial cardiac arrest. 1996

R A Berg, and C W Otto, and K B Kern, and R W Hilwig, and A B Sanders, and C P Henry, and G A Ewy
Department of Pediatrics, Steele Memorial Children's Research Center, Tucson, AZ, USA.

OBJECTIVE To determine whether high-dose epinephrine administration during cardiopulmonary resuscitation (CPR) in a swine pediatric asphyxial cardiac arrest model improves outcome (i.e., resuscitation rate, survival rate, and neurologic function) compared with standard-dose epinephrine. METHODS A randomized, blinded study. METHODS A large animal cardiovascular laboratory at a university. METHODS Thirty domestic piglets (3 to 4 months of age) were randomized to receive standard-dose epinephrine (0.02 mg/kg) or high-dose epinephrine (0.2 mg/kg) during CPR after 10 mins of cardiac standstill with loss of aortic pulsation after endotracheal tube clamping. METHODS Two minutes of CPR were provided, followed by advanced pediatric life support. Successfully resuscitated animals were supported in an intensive care unit (ICU) setting for 2 hrs and then observed for 24 hrs. RESULTS Electrocardiogram, thoracic aortic blood pressure, and right atrial blood pressure were monitored continuously until the intensive care period ended. Survival rate and neurologic outcome were determined. Return of spontaneous circulation was obtained in 13 of 15 high-dose epinephrine piglets vs. ten of 15 standard-dose epinephrine piglets (p < .20). Four of 13 high-dose piglets died in the ICU period after initial resuscitation vs. 0 of ten standard-dose piglets (p < or = .05). Nine high-dose piglets survived 2 hrs vs. ten standard-dose piglets. Three piglets in each group survived for 24 hrs, but all were severely neurologically impaired. Two minutes after resuscitation, piglets treated with high-dose epinephrine had higher heart rates (210 +/- 24 vs. 189 +/- 40 beats/min, p < .05) and higher aortic diastolic pressures (121 +/- 39 vs. 74 +/- 40 mm Hg, p < .01). Within 10 mins of return of spontaneous circulation, severe tachycardia (> 240 beats/min) was more frequently noted in the high-dose group than in the standard-dose group (p < .05). All four high-dose piglets that died in the ICU period experienced ventricular fibrillation within 10 mins of return of spontaneous circulation. CONCLUSIONS High-dose epinephrine did not improve 2-hr survival rate, 24-hr survival rate, or neurologic outcome. High-dose epinephrine resulted in severe tachycardia and hypertension immediately after resuscitation and in a higher mortality rate immediately after resuscitation.

UI MeSH Term Description Entries
D011897 Random Allocation A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. Randomization,Allocation, Random
D001794 Blood Pressure PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS. Systolic Pressure,Diastolic Pressure,Pulse Pressure,Pressure, Blood,Pressure, Diastolic,Pressure, Pulse,Pressure, Systolic,Pressures, Systolic
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D004195 Disease Models, Animal Naturally-occurring or experimentally-induced animal diseases with pathological processes analogous to human diseases. Animal Disease Model,Animal Disease Models,Disease Model, Animal
D004837 Epinephrine The active sympathomimetic hormone from the ADRENAL MEDULLA. It stimulates both the alpha- and beta- adrenergic systems, causes systemic VASOCONSTRICTION and gastrointestinal relaxation, stimulates the HEART, and dilates BRONCHI and cerebral vessels. It is used in ASTHMA and CARDIAC FAILURE and to delay absorption of local ANESTHETICS. Adrenaline,4-(1-Hydroxy-2-(methylamino)ethyl)-1,2-benzenediol,Adrenaline Acid Tartrate,Adrenaline Bitartrate,Adrenaline Hydrochloride,Epifrin,Epinephrine Acetate,Epinephrine Bitartrate,Epinephrine Hydrochloride,Epinephrine Hydrogen Tartrate,Epitrate,Lyophrin,Medihaler-Epi,Acetate, Epinephrine
D006323 Heart Arrest Cessation of heart beat or MYOCARDIAL CONTRACTION. If it is treated within a few minutes, heart arrest can be reversed in most cases to normal cardiac rhythm and effective circulation. Asystole,Cardiac Arrest,Cardiopulmonary Arrest,Arrest, Cardiac,Arrest, Cardiopulmonary,Arrest, Heart,Asystoles
D006339 Heart Rate The number of times the HEART VENTRICLES contract per unit of time, usually per minute. Cardiac Rate,Chronotropism, Cardiac,Heart Rate Control,Heartbeat,Pulse Rate,Cardiac Chronotropy,Cardiac Chronotropism,Cardiac Rates,Chronotropy, Cardiac,Control, Heart Rate,Heart Rates,Heartbeats,Pulse Rates,Rate Control, Heart,Rate, Cardiac,Rate, Heart,Rate, Pulse
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D001237 Asphyxia A pathological condition caused by lack of oxygen, manifested in impending or actual cessation of life. Suffocation,Asphyxias,Suffocations

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