To determine whether adrenergic drugs administered during cardiopulmonary resuscitation (CPR) alter the distribution of artificial card:l.ac output, we measu"red regional blood flow and cardiac output using radioactive microspheres in 12 dogs. Ventricular fibrillation was induced electrically and CPR was immediately begun with a mechanical chest compressor and ventilator (Thurn per ( R) ) at 60 compressions/min, with a ventilation:compression ratio of 1:5, a compression duration of 0.5 sec, and a ventilation pressure of 20 em H 2 o. Compression force was sufficient to develop 40-50 mmHg peak intraesophageal pressure. After 30 sec of CPR, either 0.9% saline vehicle or 50 ug/kg of epinephrine, phenylephrine, or isoproterenol was administered through a central venous catheter. One minute later, microspheres were injected into the left ventricle. After 250 sec of CPR the ventricles were defibrillated electrically. Twenty minute recovery periods were interposed between each drug injection. accord:l.ng Each dog recei.ved to predetermlned all three drugs and saline sequence. Following saline, epinephrine, phenylephrine, and isoproterenol treatment respectively, cardiac output averaged 392, 319, 255, and 475 ml/min; bratn blood flow averaged 37, 54, 2 9 ' and 28 ml/min; heart blood flow averaged 25, 79, 26, and IS ml/min; and kidney blood flow averaged 44, 4, 16, and 29 ml/min. Epinephrine improved blood flow t6 the brain, probably because of its alpha adrenergic activity. Epinephrine improved blood flow to the heart during CPR much more than the other agents, probably because of its combined alpha and beta adrenergic activity. This effect may explain its superiority in restoring circulation after prolonged arrest and resuscitation. Isoproterenol should not be used in CPR because it shunts blood away from vital organs.
Date of this Version
Holmes, H R.; Babbs, Charles F.; Voorhees, W D.; Tacker, W A.; and de Garavilla, B, "Influence of Adrenergic Drugs Upon Vital Organ Perfusion During CPR" (1980). Weldon School of Biomedical Engineering Faculty Publications. Paper 37.