Abstract 224: Repetitive Doses of Epinephrine Do Not Improve Myocardial Flow and Outcome: A Randomized Porcine Study

The aim of this study was to evaluate the effect of repetitive doses of epinephrine (EPI) on coronary perfusion pressure (CPP), coronary flow expressed as average peak velocity (APV) in the left anterior descending artery (LAD) and ventricular fibrillation waveform analysis (AMSA). Method: 36 pigs were randomized to receive EPI of 0.03 mg/kg (0.03 group), 0.02 mg/kg (0.02 group), or to NaCl (Control group). Following one minute of ventricular fibrillation, 15 minutes of mechanical chest compressions according to guidelines were given (LUCAS™2, Physio-Control/Jolife AB Sweden). During the chest compression period EPI or NaCl were given every 3 rd minute. Calculations of CPP, APV and AMSA values were done at the time of injection and at the following peak value of each parameter measured. Number of ROSC animals in each group was also evaluated. There was a significant increase in CPP at peak 1 (47 mmHg vs. 29 mmHg, P = 0.013) in the 0.03 group and at peak 2 (50 mmHg vs. 28 mmHg P = 0.023) and 3 (42 mmHg vs. 28 mmHg, P = 0.026) in the 0.02 group compared to the Control group. APV was significantly increased only at peak 1 (19 cm/s vs. 11 cm/s, P = 0.018) in the 0.03 group when compared to the Control group. There was no significant difference at any time comparing the AMSA values between groups. ROSC was obtained in 58%, 58% and 84% of animals in, 0.03, 0.02 and Control group respectively, however this difference was not significant. Conclusion: During high quality chest compressions, repetitive doses of EPI increased CPP during the first 3 injections. Flow in LAD only increased following the first injection and AMSA did not improve at any time.