The goal of CPR is to artificially generate blood flow when the heart is no longer beating. Yet, the blood flow generated is only a fraction of the normal cardiac output, and often fails to increase the aortic pressure and the corresponding coronary blood flow at the levels required to attenuate myocardial ischemia and help reestablish cardiac activity.
Epinephrine is the currently recommended vasopressor agent for CPR and is given to increase the aortic blood pressure by promoting peripheral vasoconstriction. Epinephrine is very effective and can increase initial resuscitation by threefold. However, adverse effects on the myocardium and probably the cerebral circulation compromise ultimate survival with good neurological outcome.1,2
Studies at the Resuscitation Institute support strategies for more effective vasopressor therapy, including the use of NHE-1 inhibitors to attenuate the adverse myocardial effects of epinephrine3,4 and the use of alternative vasopressors agent without the adverse effect of epinephrine.5
- Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, Regan S, Long J, Slowther A, Pocock H, Black JJM, Moore F, Fothergill RT, Rees N, O’Shea L, Docherty M, Gunson I, Han K, Charlton K, Finn J, Petrou S, Stallard N, Gates S, Lall R; PARAMEDIC2 Collaborators. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2018 Aug 23;379(8):711-721.
- Gazmuri RJ, Aiello S. Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2019 Jan 24;380(4):394-5..
- Kolarova J, Yi Z, Ayoub IM, Gazmuri RJ. Cariporide potentiates the effects of epinephrine and vasopressin by nonvascular mechanisms during closed-chest resuscitation. Chest. 2005 Apr;127(4):1327-34.
- Ayoub IM, Kolarova J, Kantola RL, Sanders R, Gazmuri RJ. Cariporide minimizes adverse myocardial effects of epinephrine during resuscitation from ventricular fibrillation. Crit Care Med. 2005 Nov;33(11):2599-605.
- Lamoureux L, Whitehouse K, Radhakrishnan J, Gazmuri RJ. Zoniporide combined with alpha-methylnorepinephrine promotes greater hemodynamic stability than either agent alone during chest compression in rats. Circulation 2014;130:A149 (Abstract).
We are studying more effective vasopressor therapies for CPR.