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Treatment of prolonged ventricular fibrillation. Immediate countershock versus high-dose epinephrine and CPR preceding countershock
Journal article   Open access   Peer reviewed

Treatment of prolonged ventricular fibrillation. Immediate countershock versus high-dose epinephrine and CPR preceding countershock

J T Niemann, C B Cairns, J Sharma and R J Lewis
Circulation (New York, N.Y.), v 85(1), 281
Jan 1992
DOI: https://doi.org/10.1161/01.CIR.85.1.281
PMID: 1728458
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1161/01.CIR.85.1.281View
Published, Version of Record (VoR) Open

Abstract

Animals Cardiopulmonary Resuscitation Dogs Dose-Response Relationship, Drug Electric Countershock Epinephrine - administration & dosage Epinephrine - therapeutic use Female Life Support Care Male Time Factors Ventricular Fibrillation - therapy
Early countershock of ventricular fibrillation has been shown to improve immediate and long-term outcome of cardiac arrest. However, a number of investigations in the laboratory and in the clinical population indicate that immediate countershock of prolonged ventricular fibrillation most commonly is followed by asystole or a nonperfusing spontaneous cardiac rhythm, neither of which rarely respond to current therapy. The use of epinephrine in doses greater than those currently recommended has recently been shown to improve both cerebral and myocardial perfusion during cardiopulmonary resuscitation (CPR). The purpose of this study was to compare cardiac resuscitation outcome between immediate countershock of prolonged ventricular fibrillation with high-dose epinephrine therapy and conventional CPR before countershock of prolonged ventricular fibrillation in a canine model. After sedation, intubation, induction of anesthesia, and instrumentation, ventricular fibrillation was electrically induced in 28 dogs. After 7.5 minutes of ventricular fibrillation, animals were randomly allocated to two treatment groups: group 1, immediate countershock followed by recommended advanced cardiac life support (ACLS) interventions, or group 2, 0.08 mg/kg epinephrine and manual closed-chest CPR before countershock and ACLS. In both groups, ACLS was continued until a spontaneous perfusing rhythm was restored or for 20 minutes (total arrest time, 27.5 minutes). A spontaneous perfusing rhythm was restored in three of 14 group 1 animals and in nine of 14 group 2 animals (p = 0.014 by sequential analysis method of Whitehead). Coronary perfusion pressure (aortic minus right atrial pressure during CPR diastole) before countershock was significantly greater in group 2 (21 +/- 7 mm Hg) when compared with mean circulatory pressure in group 1 (9 +/- 8, p less than 0.01). The findings of this study suggest that a brief period of myocardial perfusion before countershock improves cardiac resuscitation outcome from prolonged ventricular fibrillation.

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140 citations in Web of Science
176 citations in Scopus

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Web of Science research areas
Cardiac & Cardiovascular Systems
Peripheral Vascular Disease
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