The effect of terlipressin on vital organ perfusion in cardiopulmonary resuscitation – experimental study TERCA (Terlipressin in Cardiac Arrest)
Authors:
Truhlář Anatolij 1,2; Turek Zdeněk 1; Škulec Roman 1,3; Černý Vladimír 1,4
Authors place of work:
Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové
1; Zdravotnická záchranná služba Královéhradeckého kraje, Hradec Králové
2; Územní středisko záchranné služby Středočeského kraje, Beroun
3; Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
4
Published in the journal:
Anest. intenziv. Med., 22, 2011, č. 6, s. 328-336
Category:
Intensive Care Medicine - Original Paper
Summary
Objective:
Vasoactive drugs are used in cardiopulmonary resuscitation to increase vital organ perfusion. The aim of this study was to compare the haemodynamic effects of synergistically acting terlipressin and adrenaline vs. adrenaline alone in a porcine model of ventricular fibrillation (VF).
Design:
Randomized, double-blinded, placebo controlled experimental study.
Setting:
Department of Anaesthesiology and Intensive Care Medicine, University Hospital; Animal Research Laboratory, Faculty of Military Health Sciences
Materials and methods:
Fourteen domestic pigs were randomly assigned into group TER (n = 7) and ADR (n = 7). VF was induced using an intra-cardiac pacing lead. After 5 min of untreated arrest, compression-only resuscitation was applied for 10 min, followed by advanced life support. Terlipressin in a single-dose of 30 μg ·kg-1 was added to the first dose of adrenaline in group TER, while placebo was given in group ADR. Coronary (CorPP) and cerebral (CPP) perfusion pressures were calculated from the right atrial, aortic and intracerebral pressures. Data were analysed using repeated measurements ANOVA and a Fisher’s protected LSD post hoc test.
Results:
Terlipressin/adrenaline maintained CorPP higher than 10 mm Hg for 17.7 min longer than adrenaline alone (P = 0.003). CorPP (mean ± SD) measured at 35, 45, and 55 min after the onset of VF was 12.2 ± 4.0, 11.0 ± 6.2, and 9.6 ± 4.5 mm Hg in group TER; and 5.8 ± 3.8, 0.6 ± 4.9, and -1.0 ± 4.5 mm Hg in group ADR (P = 0.03, < 0.001, and < 0.001). CPP measured at the same times was 23.0 ± 7.2, 20.4 ± 6.9, and 23.1 ± 6.7 mm Hg in group TER; and 13.3 ± 6.5, 6.2 ± 5.3, and 5.6 ± 6.5 mm Hg in group ADR (P = 0.01, < 0.001, and < 0.001).
Conclusion:
A single dose of terlipressin, when added to adrenaline in cardiopulmonary resuscitation, was effective for achieving significantly higher cerebral and coronary perfusion pressures compared to adrenaline alone, which was unable to prevent severe refractory hypoperfusion.
Keywords:
cardiopulmonary resuscitation – cardiac arrest – ventricular fibrillation – therapy – terlipressin – cerebral perfusion pressure – coronary perfusion pressure
Zdroje
1. Nolan, J. P., Soar, J., Zideman, D. A., Biarent, D., Bossaert, L. L., Deakin, C. et al., on behalf of the European Resuscitation Council Guidelines Writing Group European Resuscitation Council Guidelines for Resuscitation 2010. Section 1. Executive summary. Resuscitation, 2010, 81, p. 1219–1276.
2. Safar, P. Community-wide cardiopulmonary resuscitation. J. Iowa Med. Soc., 1964, 54, p. 629–635.
3. Del Guercio, L. M. R., Coomaraswany, R., State, D. Cardiac output and other hemodynamic variables during external massage in man. N. Engl. J. Med., 1963, 269, p. 1398.
4. Paradis, N. A., Martin, G. B., Rivers, E. P., Goetting, M. G., Appleton, T. J., Feingold, M., Nowak, R. M. Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA, 1990, 263, p. 1106–1113.
5. Ebmeyer, U., Katz, L. M., Guerci, A. D. Methods to improve cerebral blood flow and neurological outcome after cardiac arrest. In: Paradis, N. A., Halperin, H. R., Kern, K. B., Wenzel, V., Chamberlain, D. A. Cardiac arrest: The science and practice of resuscitation medicine. 2nd ed. New York: Cambridge University Press, 2007, p. 389–394.
6. Deakin, C. D., Nolan, J. P., Soar, J., Sunde, K., Koster, R. W., Smith, G. B., Perkins, G. D. European Resuscitation Council guidelines for resuscitation 2010. Section 4. Adult advanced life support. Resuscitation, 2010, 81, p. 1305–1352.
7. Lindner, K. H., Dirks, B., Strohmenger, H. U., Prengel, A. W., Lindner, A. W., Lurie, K. G. A randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation. Lancet, 1997, 347, p. 535–537.
8. Wenzel, V., Krismer, A. C., Arntz, H. R., Sitter, H., Stadlbauer, K. H., Lindner, K. H. A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N. Engl. J. Med., 2004, 350, p. 105–113.
9. Gueugniaud, P. Y., David, J. S., Chanzy, E., Hubert, H., Dubien, P. Y., Mauriaucourt, P. et al. Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. N. Engl. J. Med., 2008, 359, p. 21–30.
10. Leone, M. Terlipressin or Europressin? Crit. Care, 2009, 13, p. 192.
11. Zuidema, X., Dünser, M. W., Wenzel, V., Rozendaal, F. W., de Jager, C. P. Terlipressin as an adjunct vasopressor in refractory hypotension after tricyclic antidepressant intoxication. Resuscitation, 2007, 72, p. 319–323.
12. Rocq, N., Favier, J. C., Plancade, D., Steiner, T., Mertes, P. M. Successful use of terlipressin in post-cardiac arrest resuscitation after an epinephrine-resistant anaphylactic shock to suxamethonium. Anesthesiology, 2007, 107, p. 166–167.
13. Matok, I., Vardi, A., Augarten, A., Efrati, O., Leibovitch, L., Rubinshtein, M., Paret, G. Beneficial effects of terlipressin in prolonged pediatric cardiopulmonary resuscitation: a case series. Crit. Care Med., 2007, 35, p. 1161–1164.
14. López-Herce, J., Gil-Antón, J., Morteruel, E., Carrillo, A., Rodríguez-Núñez, A. Terlipressin for paediatric cardiac arrest refractory to advanced resuscitation. Resuscitation, 2008, 77, p. S32.
15. Fernández, B., Mencía, S., López-Herce, J., Sánchez, C., Urbano, J., Rodríguez-Núñez, A. Resuscitation from post-asphyxial cardiac arrest with adrenaline and terlipressin in a paediatric animal model. Resuscitation, 2008, 77, p. S32.
16. Gil-Antón, J., López-Herce, J., Morteruel, E., Carrillo, A., Rodríguez-Núñez, A. Pediatric cardiac arrest refractory to advanced life support: Is there a role for terlipressin? Pediatr. Crit. Care Med., 2010, 11, p. 139–141.
17. Kam, P. C. A., Williams, S., Yoong, F. F. Y. Vasopressin and terlipressin: pharmacology and its clinical relevance. Anaesthesia, 2004, 59, p. 993–1001.
18. Kaiser, G. M., Frühauf, N. R. Method of intracranial pressure monitoring and cerebrospinal fluid sampling in swine. Lab. Anim., 2007, 41, p. 80–85.
19. Bricker, S. (Raised) Intracranial pressure. In Bricker, S. The Anaesthesia Science Viva Book, 2nd ed. Cambridge: Cambridge University Press, 2005, p. 124–128.
20. Krep, H., Mamier, M., Breil, M., Heister, U., Fischer, M., Hoeft, A. Out-of-hospital cardiopulmonary resuscitation with the AutoPulse system: A prospective observational study with a new load-distributing band chest compression device. Resuscitation, 2007, 73, p. 86–95.
21. Morelli, A., Ertmer, C., Rehberg, S., Lange, M., Orecchioni, A., Cecchini, V. et al. Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): a randomized, controlled pilot study. Crit. Care, 2009, 13, p. R130.
22. Kern, K. B., Halperin, H. R., Field, J. R. New guidelines for cardiopulmonary resuscitation and emergency cardiac care: changes in the management of cardiac arrest. JAMA, 2001, 285, p. 1267–1269.
23. Meybohm, P., Cavus, E., Dörges, V., Steinfath, M., Sibbert, L., Wenzel, V. et al. Revised resuscitation guidelines: adrenaline versus adrenaline/vasopressin in a pig model of cardiopulmonary resuscitation – a randomised, controlled trial. Resuscitation, 2007, 75, p. 380–388.
24. Delmas, A., Leone, M., Rousseau, S., Albanèse, J., Martin, C. Clinical review: Vasopressin and terlipressin in septic shock patients. Crit. Care, 2005, 9, p. 212–222.
25. Ryckwaert, F., Virsolvy, A., Fort, A., Murat, B., Richard, S., Guillon, G., Colson, P. Terlipressin, a provasopressin drug exhibits direct vasoconstrictor properties: consequences on heart perfusion and performance. Crit. Care Med., 2009, 37, p. 876–881.
26. Olasveengen, T. M., Sunde, K., Brunborg, C., Thowsen, J., Steen, P. A., Wik, L. Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial. JAMA, 2009, 302, p. 2222–2229.
27. Spöhr, F., Wenzel, V., Böttiger, B. W. Thrombolysis and other drugs during cardiopulmonary resuscitation. Curr. Opin. Crit. Care, 2008, 14, p. 292–298.
28. Reynolds, J. C., Rittenberger, J. C., Menegazzi, J. J. Drug administration in animal studies of cardiac arrest does not reflect human clinical experience. Resuscitation, 2007, 74, p. 13–26.
29. Mader, T. J. Prolonged cardiac arrest: a revised model of porcine ventricular fibrillation. Resuscitation, 2008, 76, p. 481–484.
30. Weisfeldt, M. L., Becker, L. B. Resuscitation after cardiac arrest: a 3-phase time-sensitive model. JAMA, 2002, 288, p. 3035–3038.
31. Gazmuri, R. J., Correa, B. M. Cardiovascular function and vascular tone: Physiology for ECC. In: Paradis, N. A., Halperin, H. R., Kern, K. B., Wenzel, V., Chamberlain, D. A. Cardiac arrest: The science and practice of resuscitation medicine. 2nd ed. New York : Cambridge University Press, 2007, p. 395–409.
32. Sharff, J. A., Pantley, G., Noel, E. Effect of time on regional organ perfusion during two methods of cardiopulmonary resuscitation. Ann. Emerg. Med., 1984, 13, p. 649–656.
33. Fries, M., Tang, W., Chang, Y. T., Wang, J., Castillo, C., Weil, M. H. Microvascular blood flow during cardiopulmonary resuscitation is predictive of outcome. Resuscitation, 2006, 71, p. 248–253.
34. Ioannou, G., Doust, J., Rockey, D. C. Terlipressin for acute esophageal variceal hemorrhage. Cochrane Database Syst. Rev., 2003, 1, p. CD002147.
35. Leone, M., Albanèse, J., Delmas, A., Chaabane, W., Garnier, F., Martin, C. Terlipressin in catecholamine-resistant septic shock patients. Shock, 2004, 22, p. 314–319.
Štítky
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineČlánok vyšiel v časopise
Anaesthesiology and Intensive Care Medicine
2011 Číslo 6
Najčítanejšie v tomto čísle
- Principles of mechanical ventilation in chronic obstructive pulmonary disease
- Severe course of Still’s disease with multiple organ failure with predominant liver failure
- The fascial plane concept
- To cool or not to cool? Obstacles to implementing therapeutic hypothermia guidelines