JAMA : the journal of the American Medical Association
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Clinical Trial Controlled Clinical Trial
The effect of standard- and high-dose epinephrine on coronary perfusion pressure during prolonged cardiopulmonary resuscitation.
We studied the effect of standard and high doses of epinephrine on coronary perfusion pressure during cardiopulmonary resuscitation in 32 patients whose cardiac arrest was refractory to advanced cardiac life support. Simultaneous aortic and right atrial pressures were measured and plasma epinephrine levels were sampled. Patients remaining in cardiac arrest after multiple 1-mg doses of epinephrine received a high dose of 0.2 mg/kg. ⋯ High-dose epinephrine was more likely to raise the coronary perfusion pressure above the previously demonstrated critical value of 15 mm Hg. The highest arterial plasma epinephrine level after a standard dose was 152 +/- 162 ng/mL, and after a high dose, 393 +/- 289 ng/mL. Because coronary perfusion pressure is a good predictor of outcome in cardiac arrest, the increase after high-dose epinephrine may improve rates of return of spontaneous circulation.
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Over the past 20 years, there has been a dramatic increase in the use of ultrasonography as an imaging modality. The introduction of real-time ultrasonography and Doppler units for the measurement of blood flow in the 1970s, recent advances in transducer design, signal processing, and miniaturization of electronics, along with the lack of radiation exposure, have been primarily responsible for the increased use of ultrasound. However, although ultrasonography can provide diagnostic information safely and easily, interpretation of the information requires an understanding of the physics behind ultrasound, how that physics is translated into ultrasound instrumentation, recognition of artifacts that are associated with the various types of ultrasonography, and identification of these artifacts in specific anatomic locations.
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Adults resuscitated from nontraumatic cardiac arrest who received intravenous epinephrine in doses chosen by the treating physician and who survived at least 6 hours were studied to determine if high-dose epinephrine produced more complications than standard-dose. A total of 68 patients were enrolled and evaluated for postresuscitation complications attributable to epinephrine, using a two-tailed t test, and contingency analysis. ⋯ Hospital discharge rates (18% in the high-dose vs 30% in the standard-dose group) and neurological status on discharge were not significantly different. High-dose epinephrine did not produce increased direct complications in this cardiac arrest population compared with standard-dose epinephrine.