Skip to main content
SpringerLink
Log in

Recent Observations on Pharmacological Interventions During CPR

  • Chapter
Book cover Perioperative and Critical Care Medicine

  • 140 Accesses

Abstract

Myocardial dysfunction, accounts for death during the first 72 h after resuscitation from cardiac arrest. When the heart stops beating, ischemic injury of myocytes follows cessation of coronary blood flow. The severity of injury is contingent on the duration of the “no-flow” interval. When ventricular fibrillation (VF) was electrically induced in 20 male pigs and animals were randomized to 4 or 7 min of untreated cardiac arrest, the severity of post-resuscitation myocardial dysfunction was proportional to the duration of untreated VF [1]. This conclusion is also supported by human data reported by Schultz et al. [2]. Even precordial compression fails to fully supply coronary blood flow in amounts that fulfill myocardial oxygen needs during VF [3]. With the aid of esophageal echocardiographic measurements, our research team has demonstrated ischemic contracture of the heart with increased thickness of the inter-ventricular septum and the left ventricular free wall during prolonged CPR. This accounts for the “stony heart” [4]. Compliance of the left ventricle is greatly reduced with progressive reductions in stroke volumes. On a cellular level, the stone heart is best explained by intracellular calcium overload during ischemie injury and probably due to reperfusion.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Tang W, Weil MH, Sun S et al (1999) The effect of biphasic and conventional monophasic defibrillation on post-resuscitation myocardial dysfunction.J Am Coll Cardiol 34:815–822

    Article  CAS  PubMed  Google Scholar 

  2. Schultz CH, Rivers EP, Feldkamp CS et al (1993) A characterization of hypothalamic-pituitary-adrenal axis function during and after human cardiac arrest. Crit Care Med 21:1339–1347

    CAS  PubMed  Google Scholar 

  3. Tang W, Weil MH, Schock RB et al (1997) Phased chest and abdominal compression-decompression: a new option for cardiopulmonary resuscitation. Circulation 95:1335–1340

    Article  CAS  PubMed  Google Scholar 

  4. Klouche K, Weil MH, Sun S et al (2002) Evolution of the stone heart after prolonged cardiac arrest. Chest 122:1006–1011

    Article  PubMed  Google Scholar 

  5. Wortsman J, Frank S, Cryer PE (1984) Adrenomedullary response to maximal stress in humans. Am J Med 77:779–784

    Article  CAS  PubMed  Google Scholar 

  6. Little RA, Frayn KN, Randall PE et al (1985) Plasma catecholamines in patients with acute myocardial infarction and in cardiac arrest. Q J Med 54:133–140

    CAS  PubMed  Google Scholar 

  7. Kern K, Elchisak MA, Sanders AB et al (1989) Plasma catecholamine and resuscitation from prolonged cardiac arrest. Crit Care Med 17:786–791

    CAS  PubMed  Google Scholar 

  8. Tang W, Weil MH, Sun S et al (1995) Epinephrine increases the severity of post-resuscitation myocardial dysfunction. Circ 92:3089–3093

    Article  CAS  Google Scholar 

  9. Ditchey RV, Lindenfeld J (1988) Failure of epinephrine to improve the balance between myocardial oxygen supply and demand during closed-chest resuscitation in dogs. Circulation 78:382–389

    Article  CAS  PubMed  Google Scholar 

  10. Jennings RB, Reimer KA, Steenbergen C (1986) Myocardial ischemia revisited: the osmolar load, membrane damage and perfusion. J Mol Cell Cardiol 18:769–780

    Article  CAS  PubMed  Google Scholar 

  11. Liversay JJ, Follette D, Fey KH et al (1978) Optimizing myocardial supply/demand balance with alpha-adrenergic drugs during cardiopulmonary resuscitation. J Thorac Cardiovasc Surg 76:244–251

    Google Scholar 

  12. Roberts D, Landolfo K, Dobson K, Light RB (1990) The effects of methoxamine on survival and regional distribution of cardiac output in dogs with prolonged ventricular fibrillation. Chest 98:999–1005

    Article  CAS  PubMed  Google Scholar 

  13. Berg RA, Otto CW, Kern K et al (1994) High dose of epinephrine results in greater early mortality after resuscitation from prolonged cardiac arrest in pigs: a prospective randomized study. Crit Care Med 22:282–290

    CAS  PubMed  Google Scholar 

  14. Holmberg M, Holmberg S, Herlitz J (2002) Low chance of survival among patients requiring adrenaline (epinephrine) or intubation after out-of-hospital cardiac arrest in Sweden. Resuscitation 54:37–45

    Article  PubMed  Google Scholar 

  15. Laurent I, Monchi M, Chiche J et al (2002) Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol 40:2110–2116

    Article  PubMed  Google Scholar 

  16. Gonzales ER, Ornato JP, Garnet AR et al (1989) Dose-dependent vasopressor response to phenylephrine during CPR in human beings. Ann Emerg Med 18:920–926

    Article  Google Scholar 

  17. Tang W, Weil MH, Gazmuri RJ et al (1991) Pulmonary ventilation/perfusion defects induced by epinephrine during cardiopulmonary resuscitation. Circ 84:2101–2107

    Article  CAS  Google Scholar 

  18. Lindner KH, Strohmenger HU, Ensinger H et al (1992) Stress hormone response during and after cardiopulmonary resuscitation. Anesthesiology 77:662–668

    Article  CAS  PubMed  Google Scholar 

  19. Wenzel V, Lindner KH, Krismer AC et al (2000) Improved survival and neurological outcome with vasopressin after prolonged resuscitation in pigs. J Am Coll Cardiol 35:527–533

    Article  CAS  PubMed  Google Scholar 

  20. Prengel AW, Lindner KH, Keller A (1996) Cerebral oxygenation during cardiopulmonary resuscitation with epinephrine and vasopressin in pigs. Stroke 27:1241–1248

    Article  CAS  PubMed  Google Scholar 

  21. Prengel AW, Lindner KH, Keller A, Lurie K (1996) Cardiovascular function during the postresuscitation phase after cardiac arrest in pigs: a comparison of epinephrine versus vasopressin. Crit Care Med 24:2014–2019

    CAS  PubMed  Google Scholar 

  22. Lindner KH, Dirks B, Strohmenger HU et al (1997) Randomized comparison of epinephrine and vasopressin in patients with out-of-hospital cardiac arrest. Lancet 349:535

    Article  CAS  PubMed  Google Scholar 

  23. Lindner KH, Prengel AW, Brinkmann A et al (1996) Vasopressin administration in refractory cardiac arrest. Ann Intern Med 124:1061–1064

    Article  CAS  PubMed  Google Scholar 

  24. Stiell JG, Hebert P, Wells G et al (2001) Vasopressin versus epinephrine for in-hospital cardiac arrest: a randomized controlled trial. Lancet 358:105–109

    Article  CAS  PubMed  Google Scholar 

  25. Gold HK, Leinbach RC, Maroko PR (1976) Propranolol-induced reduction of sing of ischemic injury during acute myocardial infarction. Am J Cardiol 38:689–695

    Article  CAS  PubMed  Google Scholar 

  26. Maroko PR, Libby P, Covell JW et al (1972) Precordial S-T elevation mapping: an atraumatic method for assessing alteration in the extent of myocardial ischemic injury. Am J Cardiol 29:223–230

    Article  CAS  PubMed  Google Scholar 

  27. Obeid A, Spear R, Mookherjee S et al (1976) The effect of propranolol on myocardial energy stores during myocardial ischemia in dogs. Circ (Suppl)II:II–159

    Google Scholar 

  28. Midei MG, Sugiura S, Maughan WL et al (1990) Preservation of ventricular function by treatment of ventricular fibrillation with phenylephrine. J Am Coll Cardiol 16:489–494

    Article  CAS  PubMed  Google Scholar 

  29. Ditchey RV, Rubio-Perez A, Slinker BK (1994) Beta-adrenergic blockade reduces myocardial injury during experimental cardiopulmonary resuscitation. J Am Coll Cardiol 24:804–812

    Article  CAS  PubMed  Google Scholar 

  30. Klouche K, Weil MH, Sun S et al (2003) A comparison of alpha-methylnorepineph-rine, vasopressin and epinephrine for cardiac resuscitation. Resuscitation 57:93–100

    Article  CAS  PubMed  Google Scholar 

  31. Sun S, Weil MH, Tang W et al (2001) Alpha-Methylnorepinephrine, a selective alpha2-adrenergic agonist for cardiac resuscitation. J Am Coll Cardiol 37:951–956

    Article  CAS  PubMed  Google Scholar 

Download references

Authors
  1. G. Cammarata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. H. Weil
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste, Italy

    Antonino Gullo  & Giorgio Berlot  & 

  2. Department of Perioperative Medicine, Intensive Care and Emergency, School of Anaesthesia and Intensive Care, Cattinara University Hospital, Trieste, Italy

    U. Lucangelo

  3. Department of Anaesthesia and Intensive Care, S. Maria degli Angeli Hospital, Pordenone, Italy

    T. Pellis

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer-Verlag Italia

About this chapter

Cite this chapter

Cammarata, G., Weil, M.H. (2004). Recent Observations on Pharmacological Interventions During CPR. In: Gullo, A., Berlot, G., Lucangelo, U., Pellis, T. (eds) Perioperative and Critical Care Medicine. Springer, Milano. https://doi.org/10.1007/978-88-470-2135-8_6

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2135-8_6

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0278-4

  • Online ISBN: 978-88-470-2135-8

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation