Nitroglycerin and Epinephrine Improve Coronary Perfusion Pressure in a Porcine Model of Ventricular Fibrillation Arrest: A Pilot Study

• Published in: The Journal of emergency medicine Vol. 37; no. 4; pp. 369 - 375
• Main Authors: Kitsou, Vassiliki, MD, Xanthos, Theodoros, PHD, Stroumpoulis, Konstantinos, MD, Rokas, George, MD, Papadimitriou, Dimitrios, MD, Serpetinis, Ioannis, MD, Dontas, Ismene, PHD, Perrea, Despina, PHD, Kouskouni, Evangelia, PHD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2009
• Subjects: Animals; Cardiopulmonary Resuscitation; coronary perfusion pressure; Drug Therapy, Combination; Emergency; epinephrine; Epinephrine - administration & dosage; Female; Heart Arrest - complications; Heart Arrest - drug therapy; Injections, Intravenous; Male; Myocardial Reperfusion - methods; nitroglycerin; Nitroglycerin - administration & dosage; return of spontaneous circulation; Sus scrofa; Sympathomimetics - administration & dosage; Vasodilator Agents - administration & dosage; Ventricular Fibrillation - complications; Ventricular Fibrillation - drug therapy; coronary perfusion pressure; cardiopulmonary resuscitation; epinephrine; return of spontaneous circulation; nitroglycerin
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2008.07.003

Abstract Background: Cardiac arrest remains one of the leading causes of death worldwide. European Resuscitation Council Guidelines for Resuscitation 2005 recommend epinephrine for its treatment. Objectives: To estimate whether the administration of a vasodilatator such as nitroglycerin in combination with epinephrine during cardiopulmonary resuscitation would improve resuscitation outcome in an established model of ventricular fibrillation. Methods: Design: Prospective, randomized, blinded, controlled study. Setting: Animal research laboratory. Ventricular fibrillation was induced in 20 Landrace/Large-White pigs. It remained untreated for 8 min before attempting resuscitation precordial compressions, mechanical ventilation, and electrical defibrillation. Animals were randomized into two groups, 10 animals each. Group A received saline as placebo (10 mL dilution, bolus) and epinephrine (0.02 mg/kg). Group B received nitroglycerin (50 μg/kg) and epinephrine (0.02 mg/kg) during cardiopulmonary resuscitation. Electrical defibrillation was attempted after 10 min of ventricular fibrillation. Results: Four animals in group A restored spontaneous circulation in comparison to eight in Group B. Coronary perfusion pressure ( p < 0.0001) was significantly increased in Group B during cardiopulmonary resuscitation. Conclusion: A vasodilatator, when administered in combination with a vasopressor such as epinephrine during cardiopulmonary resuscitation, increases coronary perfusion pressure.