Comparison of the Hemodynamic Effects of Epinephrine on Blood Pressure Augmentation at 1-, 3-, and 5-Minute Dosing Intervals.

Abstract

BACKGROUND: Although current cardiopulmonary resuscitation guidelines recommend administering epinephrine at 3- to 5-minute intervals during advanced life support (ALS), scientific evidence for the optimal dosing interval for enhancing hemodynamic parameters remains limited. Therefore, we compared the hemodynamic effects of 1-, 3-, and 5-minute epinephrine dosing intervals on blood pressure augmentation in a porcine ventricular fibrillation cardiac arrest model. METHODS: Forty-two pigs were randomly assigned to 1-, 3-, and 5-minute epinephrine dosing-interval groups. After ventricular fibrillation induction and a 2-minute downtime, basic life support was initiated with a 30:2 compression-to-ventilation ratio for 8&#x2009;minutes, followed by 30&#x2009;minutes of ALS, including asynchronous ventilation at a rate of a single ventilation every 6&#x2009;seconds, with oxygen delivered at 15&#x2009;L/min. Epinephrine (0.02&#x2009;mg/kg) was administered at predetermined intervals of 1, 3, or 5&#x2009;minutes. We compared the pressure-time integrals for mean blood pressure, coronary perfusion pressure, and diastolic blood pressure among the groups over the 30-minute ALS period. RESULTS: The mean blood pressure (<0.001), coronary perfusion pressure (=0.001), and diastolic blood pressure pressure-time integrals (=0.005) were significantly higher in the 1-minute group than in the 3- and 5-minute groups. Crucially, mean blood pressure and coronary perfusion pressure pressure-time integrals remained positive in the 1-minute group but became negative in the 3- and 5-minute groups during ALS. The diastolic blood pressure pressure-time integral also remained positive for a longer duration in the 1-minute group. CONCLUSIONS: A 1-minute epinephrine dosing interval may be significantly more effective in augmenting blood pressure and critical hemodynamic parameters during ALS than are the currently recommended 3- or 5-minute intervals.