Combination of cardiac pacing and epinephrine does not always improve outcome of cardiopulmonary resuscitation

• Published in: The American journal of emergency medicine Vol. 25; no. 9; pp. 1032 - 1039
• Main Authors: Chen, Meng-Hua, MD, Liu, Tang-Wei, MD, Zeng, Zhi-Yu, MD, Xie, Lu, DPharm, Song, Feng-Qing, MD, He, Tao, MD, Mo, Shu-Rong, MD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.11.2007; Elsevier; Elsevier Limited
• Subjects: Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Cardiac Pacing, Artificial; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Combined Modality Therapy; CPR; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency medical care; Epinephrine - therapeutic use; Influence; Intensive care medicine; Medical sciences; Ostomy; Prospective Studies; Random Allocation; Rats; Rats, Sprague-Dawley; Rodents; Statistics, Nonparametric; Studies; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome; Epinephrine; Bradycardia; Intensive care; Prognosis; Arrhythmia; Heart disease; Neurotransmitter; Cardiovascular disease; Catecholamine; Excitability disorder; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2007.03.013

Abstract We hypothesized that the combination of cardiac pacing and epinephrine would yield a better efficacy for cardiopulmonary resuscitation (CPR) and the combination of 2 therapies at different opportunity would achieve the same results of CPR. Cardiac arrest was induced by clamping the tracheal tubes in 60 Sprague-Dawley rats. At 10 minutes of asphyxia, the animals were prospectively randomized into 5 groups (n = 12/group), and received saline (Sal-gro, 1 mL, intravenous [IV]), epinephrine (Epi-gro, 0.4 mg/kg, IV), pacing (Pac-gro, transesophageal cardiac pacing combined with saline 1 mL, IV), pacing + epinephrine group 1 (PE-gro1, transesophageal cardiac pacing combined with epinephrine 0.4 mg/kg, IV), or pacing + epinephrine group 2 (PE-gro2, transesophageal cardiac pacing combined with epinephrine 0.4 mg/kg, IV, 4 minutes after the transesophageal cardiac pacing initiating and failing to resuscitate the animals), followed by initiation of CPR. Restoration of spontaneous circulation in Sal-gro was lower than in Epi-gro, Pac-gro, PE-gro1, and PE-gro2 (16.67% vs 66.67%, 66.67%, 100%, and 100%; P < .05 or P < .001, respectively). The proportions of withdrawing ventilator and 2-hour survival proportions in Pac-gro and PE-gro2 were higher than in Epi-gro and PE-gro1 (8/8, 10/12 vs 1/8, 2/12, respectively, P < .01, and 7/8, 8/12 vs 1/8, 2/12, respectively, P < .05 or P < .01). Mean survival time in Pac-gro and PE-gro2 were longer than in Epi-gro and PE-gro1 ( P < .05 or P < .01). Therefore, the combination of 2 therapies does not always improve outcome of CPR. It is obvious that the combination of transesophageal cardiac pacing with delayed administration of epinephrine yields a better outcome compared to the combination of 2 therapies at the same time during CPR in a rat asphyxia cardiac arrest model.