High-dose epinephrine results in greater early mortality after resuscitation from prolonged cardiac arrest in pigs

Abstract

To determine whether high-dose epinephrine (0.2 mg/kg) during cardiopulmonary resuscitation (CPR) results in improved outcome, compared with standard-dose epinephrine (0.02 mg/kg). A prospective, randomized, blinded study. Research laboratory of a university medical center. Thirty domestic swine were randomized to receive standard- or high-dose epinephrine during CPR after 15 mins of fibrillatory cardiac arrest. Three minutes of CPR were provided, followed by advanced cardiac life support per American Heart Association guidelines. Animals that were successfully resuscitated were supported for 2 hrs in an intensice care unit (ICU) setting, and then observed for 24 hrs. Electrocardiogram, aortic blood pressure, right atrial blood pressure, and end-tidal CO2 were monitored continuously until the intensice care period ended. Survival and neurologic outcome were determined. Return of spontaneous circulation was attained in 14 of 15 animals in each group. Four of 14 high-dose epinephrine pigs died during the ICU period after return of spontaneous circulation vs. zero of the 14 standard-dose pigs (p Measurements and Main Results Within 10 mins of defibrillation, severe hypertension (diastolic pressure >120 mm Hg) occurred in 12 of 14 high-dose pigs vs. two of 14 standard-dose pigs (p 250 beats/min) occurred in seven of 14 high-dose pigs vs. zero of 14 standard-dose pigs (p Conclusions High-dose epinephrine did not improve 24-hr survival rate or neurologic outcome. Immediately after return of spontaneous circulation, most animals in the high-dose epinephrine group exhibited a hyperadrenergic state that included severe hypertension and tachycardia. High-dose epinephrine resulted in a greater early mortality rate. (Crit Care Med 1994; 22:282–290)