Adenosine Conversion of Supraventricular Tachycardia Associated with High-Dose Epinephrine Therapy for Cardiac Arrest

AbstractAdenosine has received wide acceptance as the drug of choice for initial treatment of supraventricular tachycardias (supraventricular tachycardia), and as a diagnostic adjunct in hemodynamically stable, wide-complex tachycardias. This report describes the successful use of adenosine for the treatment of supraventricular tachycardia occurring after successful initial resuscitation from ventricular fibrillation, in which a high dose of the epinephrine protocol was used.

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Critical Care Providers’ Perceptions of the Use of Vasopressin in Cardiac Arrest

American Journal of Critical Care ◽

10.4037/ajcc2005.14.6.481 ◽

2005 ◽

Vol 14 (6) ◽

pp. 481-492

Author(s):

Janie Heath ◽

Dave Hanson ◽

Rebecca Long ◽

Nancy A. Crowell

Keyword(s):

Cardiac Arrest ◽

Critical Care ◽

Ventricular Tachycardia ◽

Ventricular Fibrillation ◽

The United States ◽

Care Providers ◽

First Line ◽

Convenience Sample ◽

Drug Of Choice ◽

Line Drug

• Background Although published algorithms and guidelines list epinephrine and vasopressin as either/or choices for treatment of ventricular fibrillation and/or pulseless ventricular tachycardia, little is known about how critical care providers respond to this recommendation. • Objectives To assess the use of vasopressin as a first-line drug of choice for ventricular fibrillation and/or pulseless ventricular tachycardia and describe factors that may influence decision making for using vasopressin. • Methods A convenience sample from 4 academic medical centers in the United States was recruited to complete a 20-item survey on demographic factors such as year of last Advanced Cardiac Life Support (ACLS) provider course, specialty certification, predominant practice responsibility, and beliefs related to the use of vasopressin for cardiac arrest. Descriptive statistics, Pearson correlation analysis, and logistic regression were used to analyze the data. • Results A total of 214 critical care providers (80% registered nurses) completed the survey. Year of last ACLS course (r = −0.188, P = .006) was a significant demographic factor, and behavioral beliefs (attitude about using vasopressin) had the strongest relationship (r = 0.687, P < .001) and were the best predictor for intentions to use or recommend the use of vasopressin (beta=0.589, P<.001). • Conclusions Despite the recommendation for vasopressin as an agent equivalent to epinephrine for treatment of ventricular fibrillation and/or pulseless ventricular tachycardia, 63% of respondents used epinephrine as a first-line drug of choice. More research is needed to address the classification system for interpreting the quality of evidence that may influence practice.

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Post‐Cardiac Arrest Hydrocortisone Use Ameliorates Cardiac Mitochondrial Injury in a Male Rat Model of Ventricular Fibrillation Cardiac Arrest

Journal of the American Heart Association ◽

10.1161/jaha.120.019837 ◽

2021 ◽

Author(s):

Min‐Shan Tsai ◽

Chien‐Hua Huang ◽

Chen‐Hsu Wang ◽

Hsaio‐Ju Cheng ◽

Shih‐Ni Wu ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Rat Model ◽

Low Dose ◽

Myocardial Damage ◽

Male Rat ◽

Control Group ◽

High Dose ◽

Mitochondrial Injury ◽

Treatment Groups

Background Steroid use after cardiac arrest has been reported to improve survival and neurological outcome in cardiac arrest survivors. The study aimed to evaluate the effect of post‐arrest hydrocortisone use on myocardial damage and cardiac mitochondrial injury in a rat model of ventricular fibrillation cardiac arrest. Methods and Results Ventricular fibrillation cardiac arrest was induced and left untreated for 5 minutes in adult male Wistar rats. Cardiopulmonary resuscitation and electric shocks were then applied to achieve return of spontaneous circulation (ROSC). Successfully resuscitated animals were randomized into 3 groups: control, low‐dose hydrocortisone (2 mg/kg), and high‐dose hydrocortisone (8 mg/kg). The low‐dose hydrocortisone and high‐dose hydrocortisone (treatment) groups received intravenous hydrocortisone immediately after ROSC and the control group received saline as placebo. Each group consisted of 15 animals. Within 4 hours of ROSC, both treatment groups showed a higher cardiac output than the control group. At the fourth hour following ROSC, histological examination and transmission electron microscopy demonstrated less myocardial damage and mitochondrial injury in the animals treated with hydrocortisone. In the treatment groups, hydrocortisone mitigated the acceleration of Ca 2+ ‐induced mitochondrial swelling and suppression of complex activity observed in the control group. At the 72nd hour after ROSC, a significantly higher proportion of animals treated with hydrocortisone survived and had good neurological recovery compared with those given a placebo. Conclusions Hydrocortisone use after cardiac arrest may mitigate myocardial injury and cardiac mitochondrial damage and thus improve survival, neurological and histological outcomes in a rat model of ventricular fibrillation cardiac arrest.

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Comparison of High-Dose Epinephrine Versus Standard-Dose Epinephrine in Adult Cardiac Arrest in the Prehospital Setting

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00042989 ◽

1996 ◽

Vol 11 (3) ◽

pp. 219-222 ◽

Cited By ~ 10

Author(s):

Richard D. Carvolth ◽

Ardith J. Hamilton

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Ventricular Fibrillation ◽

Hospital Admission ◽

Standard Dose ◽

Test Group ◽

Prehospital Setting ◽

Adult Patients ◽

Control Group ◽

High Dose

AbstractObjective:To compare the efficacy of high-dose epinephrine (HDE) with standard-dose epinephrine (SDE) in the management of cardiac arrest in adults in the prehospital setting.Hypothesis:The use of HDE will improve the outcome of adult patients in cardiac arrest.Methods:In a general population of 700,000 persons, in a mixed geographical area of 2,200 square miles, a 12-month retrospective study of SDE and a 12-month prospective trial of HDE were conducted involving adult patients in cardiac arrest in the prehospital setting. Treatment was provided by paramedic-level clinicians. In the control group, patients were treated according to existing American Heart Association cardiac resuscitation guidelines using SDE (defined as 1.0 mg boluses to a maximum dose of 4 mg). In the test group, the same guidelines were revised to use HDE (defined as a rapid sequence of 5, 10, and 15 mg boluses to a total dose of 30 mg).Results:The control group included 594 patients; the test group consisted of 580 patients. The overall survival rate to hospital admission in the control group was 14.5% (84 patients) and in the test group 15.3% (89 patients). The survival rate to hospital discharge in the control group was 4.9% (29 patients) versus 4.8% (28 patients) in the test group. For patients whose initial rhythms were ventricular fibrillation, survival to admission in the control group was 20.4% (39 patients) versus 24.4% (43 patients) in the test group. Survival to discharge for patients with ventricular fibrillation in the control group was 8.9% (17 patients) versus 10.8% (19 patients) in the test group.Conclusion:There was no statistically significant difference in overall rate of survival to hospital admission or discharge between patients treated with SDE and those treated with HDE, regardless of the initial rhythm.

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