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Adrenaline effects on cerebral physiology during cardiac arrest: More to this story

2021; Elsevier BV; Volume: 168; Linguagem: Inglês

10.1016/j.resuscitation.2021.09.012

1873-1570

Julia Slovis, Ryan W. Morgan, Todd J. Kilbaugh, Robert A. Berg,

Respiratory Support and Mechanisms

Clinicians want to know: does adrenaline administration during CPR improve hemodynamics and outcomes? Adrenaline (epinephrine) has been recommended during CPR for the last five decades, in large part based on foundational translational animal studies that established improvements in coronary perfusion pressure (CoPP), cerebral perfusion pressure (CePP), myocardial blood flow, cerebral blood flow (CBF), survival, and survival with favorable neurologic outcomes. 1. Koehler R.C. Michael J.R. Guerci A.D. et al. Beneficial effect of epinephrine infusion on cerebral and myocardial blood flows during CPR. Ann Emerg Med. 1985; 14: 744-749 Abstract Full Text PDF PubMed Scopus (61) Google Scholar , 2. Schleien C.L. Dean J.M. Koehler R.C. et al. Effect of epinephrine on cerebral and myocardial perfusion in an infant animal preparation of cardiopulmonary resuscitation. Circulation. 1986; 73: 809-817 Crossref PubMed Scopus (101) Google Scholar , 3. Friess S.H. Sutton R.M. Bhalala U. et al. Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest. Crit Care Med. 2013; 41: 2698-2704 Crossref PubMed Scopus (75) Google Scholar , 4. Hardig B.M. Gotberg M. Rundgren M. et al. Physiologic effect of repeated adrenaline (epinephrine) doses during cardiopulmonary resuscitation in the cath lab setting: a randomised porcine study. Resuscitation. 2016; 101: 77-83 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar , 5. Lautz A.J. Morgan R.W. Karlsson M. et al. Hemodynamic-directed cardiopulmonary resuscitation improves neurologic outcomes and mitochondrial function in the heart and brain. Crit Care Med. 2019; 47: e241-e249 Crossref PubMed Scopus (36) Google Scholar Landmark translational animal studies by Ristagno and colleagues 6. Ristagno G. Sun S. Tang W. Castillo C. Weil M.H. Effects of epinephrine and vasopressin on cerebral microcirculatory flows during and after cardiopulmonary resuscitation. Crit Care Med. 2007; 35: 2145-2149 Crossref PubMed Scopus (115) Google Scholar , 7. Ristagno G. Tang W. Huang L. et al. Epinephrine reduces cerebral perfusion during cardiopulmonary resuscitation. Crit Care Med. 2009; 37: 1408-1415 Crossref PubMed Scopus (181) Google Scholar in the first decade of the 21st century demonstrated that adrenaline administration during CPR could decrease cerebral microcirculatory flow measured with orthogonal polarization spectral imaging and worsen cerebral oxygenation, thus challenging the concept that adrenaline during CPR improves cerebral physiology. What have we learned over the last several years to further address these pathophysiologic issues from animal models and what are the clinical implications?