Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Statement
2.2. Surgical Preparation
2.3. Experimental Protocol
2.4. Objectives and Endpoints
2.4.1. Main Objective
2.4.2. Secondary Objectives
2.4.3. Primary Endpoint
2.4.4. Secondary Endpoints
2.5. Statistical Analysis
3. Results
4. Discussion
4.1. Coronary Perfusion Pressure and Return of Spontaneous Circulation
4.2. EtCO2 and CPP Interaction
4.3. Cerebral/Peripheral Organ Perfusion and Reduced Doses of Adrenaline
4.4. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Baseline Characteristics | 1 mg Adrenaline (n = 5) | 0.50 mg Adrenaline (n = 5) | 0.25 mg Adrenaline (n = 5) |
---|---|---|---|
Weight (kg) | 61.1 (46.4; 65.7) | 53.9 (50; 63.5) | 55 (45.4; 66.3) |
ETCO2 (mmHg) | 44 (37; 51) | 44 (41; 48) | 47 (34; 55) |
SpO2 (%) | 99 (95; 100) | 97 (93; 97) | 96 (94; 97) |
HR (/min) | 93 (81; 106) | 94 (81; 118) | 101 (83; 126) |
Temperature (Celsius) | 38.8 (38.2; 40.8) | 39.3 (38.9; 40.6) | 39.4 (39.1; 39.6) |
pH | 7.39 (7.35; 7.49) | 7.42 (7.38; 7.43) | 7.38 (7.31; 7.47) |
pO2 (mmHg) | 102 (96; 143) | 119 (99; 160) | 96 (88; 194) |
pCO2 (mmHg) | 49 (42; 53) | 49 (47; 51) | 52 (40; 60) |
Lactate (mmol/L) | 1.7 (1.2; 2.4) | 1.4 (1; 1.8) | 1 (0.75; 2.3) |
AP systolic (mmHg) | 109 (82; 140) | 108 (100; 114) | 109 (89.5; 141) |
RAP systolic (mmHg) | 7.7 (3.12; 9.28) | 7.18 (2.32; 8.88) | 8.3 (4.79; 15) |
AP diastolic (mmHg) | 81.1 (58.4; 104) | 74.1 (61.5; 83.7) | 83.4 (52.1; 104) |
RAP diastolic (mmHg) | 3.83 (−1.49; 4.18) | 3.06 (2.25; 5.17) | 3.66 (0.902; 9.94) |
CPP (mmHg) | 76.9 (54.4; 106) | 71 (58.5; 80.4) | 79.8 (51.2; 100) |
NIRSc Baseline (%) | 54 (47; 59) | 54.5 (46.5; 65.5) | 57.5 (53.5; 69.5) |
NIRSt Baseline (%) | 41 (38; 62) | 31 (20; 70) | 39 (25; 43) |
ROSC | |||
No | 1 (20.0 %) | 1 (20.0 %) | 1 (20.0 %) |
Yes | 4 (80.0 %) | 4 (80.0 %) | 4 (80.0 %) |
Parameter Measured | 1 mg Adrenaline (n = 5) | 0.50 mg Adrenaline (n = 5) | 0.25 mg Adrenaline (n = 5) | p-Value 0.50 mg vs. 1 mg * | p-Value 0.25 mg vs. 1 mg * | p-Value Overall ** |
---|---|---|---|---|---|---|
CPP | ||||||
T7 | 27.8 (24.3; 42.2) | 28.6 (18.6; 33.5) | 24.5 (12; 29.8) | 0.55 | 0.15 | 0.25 |
T8.5 | 53.8 (37.8; 58.2) | 39.6 (32.7; 52.5) | 28.9 (21.2; 35.4) | 0.056 | 0.008 ‡ | 0.0007 ‡ |
Absolute Δ T7–T8.5 | 18.4 (13.4; 30.4) | 13.6 (11; 19) | 4.93 (3.31; 15.2) | 0.22 | 0.032 ‡ | 0.030 ‡ |
T12 | 36.5 (15.8; 40.4) | 23.3 (12.1; 42) | 22 (9.25; 29.6) | 0.69 | 0.095 | 0.25 |
T13.5 | 48.3 (30.2; 64.1) | 39.2 (23.5; 49.4) | 22.6 (13; 36.7) | 0.31 | 0.032 ‡ | 0.026 ‡ |
Absolute Δ T12–T13.5 | 13.2 (−6.28; 32.5) | 8.59 (5.03; 22.1) | 3.64 (−0.06; 14.7) | 0.55 | 0.31 | 0.19 |
T17 | 33 (8.14; 59.7) | 25.5 (19.5; 38.1) | 24.3 (16.3; 51.8) | 1.00 | 0.69 | 0.86 |
T18.5 | 38.2 (24.2; 69.6) | 31.9 (27; 55.6) | 24.1 (19.1; 28.3) | 1.00 | 0.032 ‡ | 0.029 ‡ |
Absolute Δ T17–T18.5 | 5.05 (−3.2; 30.1) | 7.54 (4.99; 17.5) | −0.159 (−0.342; 7.73) | 0.69 | 0.41 | 0.27 |
T22 | 15.1 (5.38; 28.8) | 21.6 (20.2; 33.8) | 21.9 (6.01; 24.7) | 0.22 | 0.73 | 0.36 |
T23.5 | 38.3 (20.3; 66.8) | 29.7 (26.8; 45.1) | 19.6 (10.5; 25.6) | 1.00 | 0.063 | 0.028 ‡ |
Absolute Δ T22–T23.5 | 9.56 (3.22; 61.4) | 8.82 (5.86; 11.3) | −0.0938 (−3.38; 4.45) | 0.84 | 0.032 ‡ | 0.017 ‡ |
T27 | 23.3 (9.56; 57.7) | 23.2 (18.9; 31.3) | 22.2 (6.59; 31.3) | 0.84 | 0.69 | 0.72 |
T28.5 | 34.1 (10.9; 62.1) | 25.3 (21.8; 45.1) | 23.5 (5.41; 48.7) | 0.55 | 0.42 | 0.55 |
Absolute Δ T27–T28.5 | 4.41 (−0.577; 26.3) | 5.55 (−1.39; 13.8) | 1.31 (−1.18; 17.4) | 1.00 | 0.55 | 0.86 |
ROSC10 | 52.5 (44.6; 58.4) | 43.3 (3.59; 66) | 54.9 (25.6; 86.1) | 0.86 | 0.86 | 0.83 |
NIRSc | ||||||
Baseline | 54 (47; 59) | 54.5 (46.5; 65.5) | 57.5 (53.5; 69.5 | 1.00 | 0.29 | 0.36 |
T32 | 32 (29.5; 43.5) | 36 (32; 49) | 42 (39.5; 59.5) | 0.46 | 0.39 | 0.34 |
ROSC10 | 51.8 (42.5; 58.5) | 47 (42; 50) | 46.8 (46; 49) | 0.69 | 1.00 | 0.92 |
NIRS T | ||||||
Baseline | 41 (38; 62) | 31 (20; 70) | 39 (25; 43) | 0.38 | 0.52 | 0.64 |
T32 | 0 (0; 0) | 6 (0; 22) | 9 (0; 12) | 0.048 ‡ | 0.048 ‡ | 0.030 ‡ |
ROSC10 | 30 (23; 37) | 38.5 (28; 57) | 29 (0; 43) | 0.23 | 1.00 | 0.47 |
CPP >35 mmHg | 1 mg Adrenaline (n = 5) | 0.50 mg Adrenaline (n = 5) | 0.25 mg Adrenaline (n = 5) | p-Value 0.50 mg vs. 1 mg | p-Value 0.25 mg vs. 1 mg | p-Value * Overall | |||
---|---|---|---|---|---|---|---|---|---|
N | n (%) | N | n (%) | N | n (%) | ||||
T8.5 | 5 | 5 (100 %) | 5 | 3 (60 %) | 5 | 1 (20 %) | 0.44 | 0.048 ‡ | 0.066 ‡ |
T13.5 | 5 | 4 (80 %) | 5 | 3 (60 %) | 5 | 1 (20 %) | 1.00 | 0.21 | 0.30 |
T18.5 | 5 | 3 (60 %) | 5 | 2 (40 %) | 4 | 0 (0 %) | 1.00 | 0.17 | 0.30 |
T23.5 | 5 | 3 (60 %) | 5 | 2 (40 %) | 4 | 0 (0 %) | 1.00 | 0.17 | 0.30 |
T28.5 | 5 | 2 (40 %) | 5 | 1 (20 %) | 5 | 1 (20 %) | 1.00 | 1.00 | 1.00 |
ROSC10 | 3 | 3 (100 %) | 4 | 2 (50 %) | 4 | 3 (75 %) | 0.43 | 1.00 | 0.71 |
ETCO2 (mmHg) | 1 mg Adrenaline (n = 5) | 0.50 mg Adrenaline (n = 5) | 0.25 mg Adrenaline (n = 5) | p-Value 0.50 mg vs. 1 mg * | p-Value 0.25 mg vs. 1 mg * | p-Value Overall ** | |||
---|---|---|---|---|---|---|---|---|---|
n | Median (Min–Max) | n | Median (Min–Max) | n | Median (Min–Max) | ||||
T7 | 5 | 28 (23; 36) | 5 | 32 (23; 37) | 5 | 29 (9; 40) | 0.71 | 0.88 | 0.79 |
T9 | 5 | 24 (18; 31) | 5 | 26 (17; 30) | 5 | 26 (16; 28) | 0.84 | 0.73 | 0.91 |
Absolute Δ T7–T9 | 5 | −5 (−11; −2) | 5 | −6 (−9; −4) | 5 | −3 (−13; 7) | 1.00 | 0.55 | 0.59 |
T12 | 5 | 19 (16; 26) | 5 | 32 (23; 35) | 5 | 21 (16; 34) | 0.016 ‡ | 0.45 | 0.032 ‡ |
T14 | 5 | 19 (12; 22) | 5 | 26 (20; 34) | 5 | 22 (18; 27) | 0.032 ‡ | 0.21 | 0.052 |
Absolute Δ T12–T14 | 5 | 0 (−6; 1) | 5 | −3 (−9; −1) | 5 | 0 (−8; 3) | 0.29 | 0.75 | 0.30 |
T17 | 5 | 19 (15; 23) | 5 | 29 (22; 37) | 5 | 23 (12; 34) | 0.016 ‡ | 0.48 | 0.049 ‡ |
T19 | 5 | 19 (16; 24) | 5 | 22 (15; 31) | 5 | 18 (10; 27) | 0.69 | 1.00 | 0.84 |
Absolute Δ T17–T19 | 5 | 0 (−3; 9) | 5 | −7 (−10; −5) | 5 | −3 (−7; 0) | 0.008 ‡ | 0.17 | 0.005 ‡ |
T22 | 5 | 17 (14; 23) | 5 | 24 (13; 29) | 5 | 20 (7; 33) | 0.29 | 0.61 | 0.49 |
T24 | 5 | 23 (12; 26) | 5 | 15 (12; 29) | 5 | 17 (8; 29) | 0.72 | 0.84 | 1.00 |
Absolute Δ T22–T24 | 5 | 0 (−2; 7) | 5 | −2 (−9; 0) | 5 | −4 (−5; 1) | 0.13 | 0.071 | 0.11 |
T27 | 5 | 19 (11; 29) | 5 | 17 (10; 32) | 5 | 16 (7; 34) | 0.89 | 0.81 | 0.95 |
T29 | 5 | 18 (11; 28) | 4 | 19 (14; 26) | 5 | 17 (6; 20) | 0.78 | 0.41 | 0.66 |
Absolute Δ T27–T29 | 5 | 0 (−1; 2) | 4 | −2 (−6; 0) | 5 | −1 (−14; 2) | 0.19 | 0.49 | 0.35 |
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Jaeger, D.; Koger, J.; Duhem, H.; Fritz, C.; Jeangeorges, V.; Duarte, K.; Levy, B.; Debaty, G.; Chouihed, T. Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest. J. Clin. Med. 2021, 10, 4674. https://doi.org/10.3390/jcm10204674
Jaeger D, Koger J, Duhem H, Fritz C, Jeangeorges V, Duarte K, Levy B, Debaty G, Chouihed T. Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest. Journal of Clinical Medicine. 2021; 10(20):4674. https://doi.org/10.3390/jcm10204674
Chicago/Turabian StyleJaeger, Deborah, Jonathan Koger, Helene Duhem, Caroline Fritz, Victor Jeangeorges, Kevin Duarte, Bruno Levy, Guillaume Debaty, and Tahar Chouihed. 2021. "Mildly Reduced Doses of Adrenaline Do Not Affect Key Hemodynamic Parameters during Cardio-Pulmonary Resuscitation in a Pig Model of Cardiac Arrest" Journal of Clinical Medicine 10, no. 20: 4674. https://doi.org/10.3390/jcm10204674