Early adrenaline administration does not improve circulatory recovery during resuscitation from severe asphyxia in newborn piglets |
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Authors: | Linner Rikard Werner Olof Perez-de-Sa Valeria Cunha-Goncalves Doris |
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Affiliation: | 1. Department of Cardiothoracic Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund SE-22185, Sweden;2. Department of Paediatric Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund SE-22185, Sweden |
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Abstract: | Aim of the studyTo investigate the effects of early intravenous adrenaline administration on circulatory recovery, cerebral reoxygenation, and plasma catecholamine concentrations, after severe asphyxia-induced bradycardia and hypotension.MethodsOne-day-old piglets were left in apnoea until heart rate and mean arterial pressure were less than 50 min−1 and 25 mmHg, respectively. They randomly received adrenaline, 10 μg kg−1 (n = 16) or placebo (n = 15) and were resuscitated with air ventilation and, when needed, closed-chest cardiac massage (CCCM). Eight not asphyxiated animals served as time controls.ResultsCCCM was required in 13 piglets given adrenaline and in 13 given placebo. Time to return of spontaneous circulation was: 72 (66–85) s vs. 77 (64–178) s [median (quartile range)] (p = 0.35). Time until cerebral regional oxygen saturation (CrSO2) had increased to 30% was 86 (79–152) s vs. 126 (88–309) s (p = 0.30). The two groups did not differ significantly in CrSO2, heart rate, arterial pressure, right common carotid artery blood flow, or number of survivors: 13 vs. 11 animals. Plasma concentration of adrenaline, 2.5 min after resuming ventilation, was 498 (268–868) nmol l−1vs. 114 (80–306) nmol l−1 (p = 0.01). Corresponding noradrenaline concentrations were 1799 (1058–4182) nmol l−1vs. 1385 (696–3118) nmol l−1 (ns). In the time controls, the concentrations were 0.4 (0.2–0.6) nmol l−1 of adrenaline and 1.8 (1.3–2.4) nmol l−1 of noradrenaline.ConclusionThe high endogenous catecholamine levels, especially those of noradrenaline, may explain why early administered adrenaline did not significantly improve resuscitation outcome. |
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Keywords: | Bpm, beats per minute BW, body weight CCCM, closed chest cardiac massage CrSO2, cerebral regional oxygen saturation HR, heart rate MAP, mean arterial pressure PbtO2, brain tissue partial pressure of oxygen RCCABF, right common carotid artery blood flow ROSC, return of spontaneous circulation SBH, severe asphyxia-induced bradycardia and hypotension P-adrenaline, plasma adrenaline P-noradrenaline, plasma noradrenaline |
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