Premium
Adrenaline increases blood‐brain‐barrier permeability after haemorrhagic cardiac arrest in immature pigs
Author(s) -
SEMENAS E.,
SHARMA H. S.,
WIKLUND L.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12293
Subject(s) - medicine , resuscitation , anesthesia , ventricular fibrillation , circulatory system , cardiopulmonary resuscitation , blood pressure , hypertonic saline , mean arterial pressure , heart rate
Background Adrenaline ( ADR ) and vasopressin ( VAS ) are used as vasopressors during cardiopulmonary resuscitation. Data regarding their effects on blood–brain barrier ( BBB ) integrity and neuronal damage are lacking. We hypothesised that VAS given during cardiopulmonary resuscitation ( CPR ) after haemorrhagic circulatory arrest will preserve BBB integrity better than ADR . Methods Twenty‐one anaesthetised sexually immature male piglets (with a weight of 24.3 ± 1.3 kg) were bled 35% via femoral artery to a mean arterial blood pressure of 25 mmHg in the period of 15 min. Afterwards, the piglets were subjected to 8 min of untreated ventricular fibrillation followed by 15 min of open‐chest CPR . At 9 min of circulatory arrest, piglets received amiodarone 1.0 mg/kg and hypertonic‐hyperoncotic solution 4 ml/kg infusions for 20 min. At the same time, VAS 0.4 U/kg was given intravenously to the VAS group ( n = 9) while the ADR group received ADR 20 μg/kg ( n = 12). Internal defibrillation was attempted from 11 min of cardiac arrest to achieve restoration of spontaneous circulation. The experiment was terminated 3 h after resuscitation. Results The intracranial pressure ( ICP ) in the post‐resuscitation phase was significantly greater in ADR group than in VAS group. VAS group piglets exhibited a significantly smaller BBB disruption compared with ADR group. Cerebral pressure reactivity index showed that cerebral blood flow autoregulation was also better preserved in VAS group. Conclusions Resuscitation with ADR as compared with VAS after haemorrhagic circulatory arrest increased the ICP and impaired cerebrovascular autoregulation more profoundly, as well as exerted an increased BBB disruption though no significant difference in neuronal injury was observed.