Abstract 13104: Comparison of Patient Characteristics and Outcomes Between Adult Non-traumatic Out-of-hospital Cardiac Arrests With and Without Extracorporeal Cardiopulmonary Resuscitation - A Community-wide Evaluation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Patrick Chow-In Ko ◽  
Nai-Kuan Chou ◽  
Matthew Huei-Ming Ma ◽  
Yu-Wen Chen ◽  
Tzong-Luen Wang ◽  
...  
Keyword(s):  
Life Support ◽  
Cerebral Performance Category ◽  
Advanced Life Support ◽  
Patient Characteristics ◽  
Spontaneous Circulation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Arrival ◽  
Advanced Airway ◽  
Younger Age ◽  
Bystander Cpr

Objectives: The outcome of patients after OHCA is poor. Return to spontaneous circulation (ROSC) dramatically decreases with the duration of CPR. Extracorporeal membrane oxygenation has been proposed to assist CPR (ECPR) in OHCA. This study was to investigate the effects and characteristics of ECPR for adult non-traumatic (ANT) OHCA versus Non-ECPR on a community-wide basis. Methods: A prospective four-year observational database collected from a community-wide OHCA web registry in an urban EMS (emergency medical services) was studied. The EMS ambulance teams were capable with advanced airway, intravenous (iv) fluid skills, basic and advanced life support and automated external defibrillator techniques. Outcomes included survival and cerebral performance category scale (CPC) at discharge. ANT OHCA with and without ECPR in emergency were compared by regression analysis including factors of patient, pre-hospital and hospital characteristics and outcomes. Results: Comparing OHCA receiving ECPR (n=79) to those without (n=959), ECPR group were younger (median age 56 vs 78 p<0.001) and had higher portion for men (89 vs 64% p<0;001), witnessed arrest (Wit) (60.8 vs 32.5% p<0.001), bystander CPR (BCPR) (53.2 vs 36.8% p=0.005), initial shockable rhythms (SR) (74.6 vs 12.2% p<0.001) and therapeutic hypothermia (TH) (22.8 vs 1.1%, p<0.001). They (EPCR vs non-ECPR) had no difference for prehospital time intervals (22.5 vs 23 min.), laryngeal mask airway treatment (55.7 vs 52.8%), EMS iv epinephrine (20.3 vs 15.5%), endotracheal intubation (6.3 vs 8.0%), prehospital ROSC (11.4 vs 6% p=0.09), and ROSC upon hospital arrival (10.1 vs 8.5%). Outcomes were better in ECPR for discharged survival (41 vs 7% p<0.001) and CPC 1or2 (20.8 vs 3.8% p<0.001). After adjusting for Wit, BCPR, SR, TH, age and sex, both survival (adjusted odds ratio: 3.6 [95% 2.0-6.6]) and good CPC 1or2 (adjusted OR: 2.9 [95% 1.2-6.9]) were still significantly higher in ECPR. Conclusions: In current emergency practice for ANT OHCA, ECPR tended to apply to patients of younger age, men, witnessed arrest, BCPR, and initially shockable rhythms regardless of positive ROSC upon hospital arrival, that can independently lead to higher survival and good neurological outcome compared to non-ECPR.

Abstract 13106: Improved Outcomes of Extracorporeal Cardiopulmonary Resuscitation for Out-of-hospital Cardiac Arrest - A Community-wide Evaluation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Wei-Shu Lin ◽  
Matthew Huei-Ming Ma ◽  
Nai-Kuan Chou ◽  
Mei-Fen Yang ◽  
Yu-Wen Chen ◽  
...  
Keyword(s):  
Neurological Outcome ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Improved Outcomes ◽  
Advanced Airway ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Introduction: The patient outcome after OHCA is poor. Return to spontaneous circulation (ROSC) dramatically decreases with the duration of CPR. It has been proposed to implement extracorporeal membrane oxygenation in order to assist CPR (ECPR) in OHCA. Objective: To investigate the effects of ECPR in emergency (ED) for OHCA. Methods: A prospective 4-year observational database collected from a community-wide OHCA registry in an urban EMS was studied. The EMS ambulance staffs were capable with advanced airway, intravenous (iv) fluid skills, basic and advanced life support and AED techniques. Outcomes included 2-hour and 24-hour sustained ROSC, survival (SD) and cerebral performance category scale (CPC) at discharge. OHCA receiving ECPR were included and their pre-hospital (pre-H) and hospital (H) characteristics and outcomes were evaluated by regression analysis. Results: In the 4 years among a total of 7,220 OHCA resuscitated in ED, ECPR was used 88 times (90% male, median age 54 [IQR 44-63]), 90% non-traumatic, 58.6% arrest witnessed, 50.6% with bystander CPR, up to 72.6% initial AED rhythm showing shockable, 54% with LMA (laryngeal mask airway), 5.7% with endotracheal intubation, 18.2% with pre-H iv epinephrine, and 12.5% of them received therapeutic hypothermia. Pre-H time intervals (min:sec, median [IQR]) were 04:38 [03:30-06:08] for response, 13:00 [10:05-16:00] for scene, and 03:08 [02:09-05:00] for transport. Only 10.2% of cases presented pre-H ROSC and 9.1% got ROSC upon H arrival. Outcomes were 88.6% for 2-hr ROSC, 69.3% for 24-hr ROSC, 39.1% for SD, and 21% for good CPC 1or2 respectively. Patients with CPC 1or2 tended to be younger (median age 46.8 vs. 55.9, p=0.04) and less with LMA (29.4 vs. 61.9%, p=0.02). Conclusions: ECPR can lead to survival and good neurological outcome in selected OHCA regardless of positive ROSC at pre-H or upon H arrival after EMS resuscitation. Elder age and pre-H LMA may be adverse to neurological outcome for OHCA with ECPR.

scholarly journals Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

2021 ◽  
Author(s):  
Pramod Chandru ◽  
Tatum Priyambada Mitra ◽  
Nitesh Dutt Dhanekula ◽  
Mark Dennis ◽  
Adam Eslick ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Rescue Therapy ◽  
A Priori ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

scholarly journals Management of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S82-S89
Author(s):  
Michael Poppe ◽  
Mario Krammel ◽  
Christian Clodi ◽  
Christoph Schriefl ◽  
Alexandra-Maria Warenits ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Medical Services ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Objective Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. Methods All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Results Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96). Conclusion An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.

Abstract 19131: The Advanced Life Support Termination of Resuscitation Rule: A Local Evaluation of the Impact on Termination Rates

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Joris Nas ◽  
Judith L Bonnes ◽  
Dominique V Verhaert ◽  
Wessel Keuper ◽  
Pierre van Grunsven ◽  
...  
Keyword(s):  
Life Support ◽  
Response Times ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Shock Delivery ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
The Impact ◽  
Termination Decisions

Introduction: Termination of Resuscitation (TOR) rules have been designed to guide in-field termination decisions and reduce futile hospital transportations. The impact of such a rule may depend on regional infrastructure, arrest characteristics and pre-existent termination rates. Our region is characterized by high rates of bystander cardiopulmonary resuscitation (CPR), and Advanced Life Support (ALS) trained rescuers authorized to make termination decisions. We aim to investigate the actual in-field termination rates and the termination rates as recommended by the ALS-TOR rule. Furthermore, we studied factors associated with the actual termination decisions. Methods: Cohort of out-of-hospital cardiac arrest patients who were resuscitated in the Nijmegen area, the Netherlands (2008-2011). The ALS-TOR rule recommends termination in case all following criteria are met: unwitnessed arrest, no bystander CPR, no shock delivery, no return of spontaneous circulation (ROSC). Results: The observed percentage of in-field termination was 46% (275/598), while the ALS-TOR rule recommended termination in only 6% (35/588), owing to high percentages of witnessed arrests (73%) and bystander CPR (54%) in our region. Factors independently associated with the actual decisions to terminate resuscitation were absence of ROSC [aOR 35.6 (95% CI 18.3-69.3)], non-shockable initial rhythm [aOR 6.0 (95% CI 3.2-11.0)], unwitnessed arrest [aOR 2.7 (95% CI 1.4-5.2)], non-public arrest [aOR 2.5 (95% CI 1.2-5.0)] and longer EMS-response times [aOR 1.1 per minute increase (95% CI 1.0-1.2)]. Conclusions: Contrary to previous studies, implementation of the ALS-TOR rule in our region would have decreased termination rates from almost half to less than 10% due to the favourable arrest characteristics. In light of the prognosis after OHCA, this finding suggests that adherence to this set of criteria does not contribute to efficient triage in our population. Therefore it seems prudent to locally evaluate the utility of the ALS-TOR rule prior to implementation.

scholarly journals Mode of Death after Extracorporeal Cardiopulmonary Resuscitation

Membranes ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 270
Author(s):  
Viviane Zotzmann ◽  
Corinna N. Lang ◽  
Xavier Bemtgen ◽  
Markus Jaeckel ◽  
Annabelle Fluegler ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Cerebral Damage ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Refractory Shock ◽  
Lactate Levels ◽  
Mode Of Death

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) might be a lifesaving therapy for patients with cardiac arrest and no return of spontaneous circulation during advanced life support. However, even with ECPR, mortality of these severely sick patients is high. Little is known on the exact mode of death in these patients. Methods: Retrospective registry analysis of all consecutive patients undergoing ECPR between May 2011 and May 2020 at a single center. Mode of death was judged by two researchers. Results: A total of 274 ECPR cases were included (age 60.0 years, 47.1% shockable initial rhythm, median time-to-extracorporeal membrane oxygenation (ECMO) 53.8min, hospital survival 25.9%). The 71 survivors had shorter time-to-ECMO durations (46.0 ± 27.9 vs. 56.6 ± 28.8min, p < 0.01), lower initial lactate levels (7.9 ± 4.5 vs. 11.6 ± 8.4 mg/dL, p < 0.01), higher PREDICT-6h (41.7 ± 17.0% vs. 25.3 ± 19.0%, p < 0.01), and SAVE (0.4 ± 4.8 vs. −0.8 ± 4.4, p < 0.01) scores. Most common mode of death in 203 deceased patients was therapy resistant shock in 105/203 (51.7%) and anoxic brain injury in 69/203 (34.0%). Comparing patients deceased with shock to those with cerebral damage, patients with shock were significantly older (63.2 ± 11.5 vs. 54.3 ± 16.5 years, p < 0.01), more frequently resuscitated in-hospital (64.4% vs. 29.9%, p < 0.01) and had shorter time-to-ECMO durations (52.3 ± 26.8 vs. 69.3 ± 29.1min p < 0.01). Conclusions: Most patients after ECPR decease due to refractory shock. Older patients with in-hospital cardiac arrest might be prone to development of refractory shock. Only a minority die from cerebral damage. Research should focus on preventing post-CPR shock and treating the shock in these patients.

scholarly journals Impact of specific emergency measures on survival of out of hospital traumatic cardiac arrest: data from the northern french alps cardiac arrest registry.

2020 ◽  
Author(s):  
Dominique Savary ◽  
François Morin ◽  
Delphine Douillet ◽  
Thierry Roupioz ◽  
François Xavier Ageron ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Tension Pneumothorax ◽  
Advanced Life Support ◽  
Traumatic Cardiac Arrest ◽  
Advanced Airway ◽  
Good Neurologic Outcome ◽  
Pelvic Stabilization ◽  
The Impact

Abstract The management of Out of hospital Traumatic Cardiac Arrest (TCA) for professional rescuers combines advanced life support with specifics actions to treat potential reversible causes of the arrest: hypovolemia, hypoxemia, Tension Pneumothorax (TPx) and tamponade. The aim of this study was to assess the impact of specific rescue gestures on short-term outcomes in the context of resuscitation of patients with a pre-hospital TCA.Methods: We conducted a retrospective study of all TCA treated in two emergency medical units (EM unit), which are part of the Northern Alps emergency network, from January 2004 to December 2017. Utstein variables and specific rescue actions in TCA were compiled: advanced airway management, fluid administration, pelvic stabilization or tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary end point was the survival rate at day 30 with good neurologic outcome (cerebral performance category [CPC] score 1 & 2).Results: 287 resuscitations attempt in TCA were included and 279 specific interventions were Identified: 262 Fluid expansion, 41 External Pelvic stabilizations, 5 tourniquets, 175 bilateral thoracostomies, (including 44 with TPx).Conclusion: Among standard resuscitation measures to treat reversible causes of cardiac arrest, we were able to show that bilateral thoracostomy and tourniquet application on a limb hemorrhage improves survival of TCA. A larger sample for pelvic stabilization is necessary.

Abstract 20: Intraosseous vs. Intravenously Administered Advanced Life Support Drugs in Patients With Out-of-Hospital Cardiac Arrest: Insights From the Resuscitation Outcomes Consortium Continuous Chest Compression Trial

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Purav Mody ◽  
Siobhan Brown ◽  
Rohan Khera ◽  
Ambarish Pandey ◽  
Colby Ayers ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Neurological Function ◽  
Access Route ◽  
Epinephrine Administration ◽  
Bystander Cpr ◽  
Hospital Cardiac Arrest

Background: There is an urgent need to identify strategies which improve outcomes for out-of-hospital cardiac arrest (OHCA). Determining the optimal access route to deliver medications during resuscitation from OHCA may be one such strategy. Methods: Using data from the Continuous Chest compression trial between 2011 and 2016, we examined rates of sustained return of spontaneous circulation (ROSC) i.e. ROSC on ER arrival, survival to discharge and survival with favorable neurological function (modified Rankin scale ≤3) among patients with attempted IV and IO access. Results: Among 19,731 patients with available access information, IO or IV access was attempted in 3,068 (15.5%) and 16,663 (84.5%) patients, respectively and was successful in 2,975 (97%) and 15,485 (92%) of these patients. Overall, patients with attempted IO access were younger, more likely female, received less bystander CPR, had lower proportions of shockable and witnessed arrests, marginally faster times to access and to epinephrine administration, and less frequently received therapeutic hypothermia and coronary angiography as compared with patients with IV access ( Table ) . Unadjusted rates of sustained ROSC, discharge survival and survival with favorable neurological function were significantly lower in patients with attempted IO access ( Table) . After adjustment for age, sex, initial rhythm, bystander CPR, public location, witnessed status, EMS response time and trial cluster, attempted IO access was associated with lower sustained ROSC rates (OR 0.79, 95% CI 0.71-0.89, p<0.001) but not with discharge survival (OR 0.88, 95% CI 0.71-1.08, p=0.21) or survival with favorable neurological function (OR 0.86, 95% CI 0.67-1.1, p=0.26). Conclusions: Among patients with OHCA, intraosseous access was attempted in 1 in 7 OHCA patients and associated with worse ROSC rates but no difference in survival. Further studies are necessary to elucidate the optimal access route among OHCA patients.

Abstract 18070: Therapies Optimizing Organ Perfusion and Protection After Out-of-hospital Cardiac Arrest Improves Survival With Favorable Neurologic Outcome

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Michael J Jacobs ◽  
Leo S Derevin ◽  
Sue Duval ◽  
James E Pointer ◽  
Karl A Sporer
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Outcome Data ◽  
Neurological Function ◽  
Inverse Association ◽  
Advanced Airway ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Survival rates with favorable neurologic function after out-of-hospital cardiac arrest (OHCA) have remained low for decades. Hypothesis: Use of therapies focused on better perfusion during CPR using mechanical adjuncts and protective post-resuscitation care would improve survival and neurologic outcomes after OHCA compared to conventional CPR and care. Methods: OHCA outcomes in Alameda County, CA, USA, population 1.5 million, from December 2009-2011 when there was incomplete availability and use of impedance threshold device [ITD], mechanical CPR [MCPR], and hospital therapeutic hypothermia [HTH], were compared to 2012 when all were available and more widely used. Return of Spontaneous Circulation (ROSC), survival and Cerebral Performance Category (CPC) scores were compared using univariate and multivariable analyses. Results: Of the 3008 non-traumatic OHCAs who received CPR during the study period, >95% of survival outcome data were available. From 2009-11 to 2012, there was an increase in ROSC from 28.6% to 34.1% (p=0.002; OR=1.28; CI=1.09, 1.51) and a non-significant increase in hospital discharge from 10.5% to 12.3% (p=0.14; OR=1.17; CI=0.92, 1.49). There was, however, an 80% increase in survival with favorable neurological function between the two periods, as determined by CPC≤2, from 4.4% to 7.9% (p<0.001; unadjusted OR=1.85; CI=1.35, 2.54). After adjusting for witnessed arrest, bystander CPR, initial rhythm (VT/VF vs. others), placement of an advanced airway, EMS response time, and age, the adjusted OR was 1.60 (1.11, 2.31; p=0.012). Using a stepwise regression model, the most important independent positive predictors of CPC≤2 were 2012 (p=0.019), witnessed (p<0.001), initial rhythm VT/VF (p<0.001), and advanced airway (inverse association p<0.001). Additional analyses of the three therapies, separately and in combination, demonstrated that for all patients admitted to the hospital, ITD use with HTH had the most impact on survival to discharge with CPC≤2 of 24%. Conclusions: Therapies (ITD, MCPR, HTH) developed to enhance circulation during CPR and cerebral recovery after ROSC, significantly improved survival with favorable neurological function by 80% following OHCA.

scholarly journals Effects of Erythropoietin Administration on Adrenal Glands of Landrace/Large White Pigs after Ventricular Fibrillation

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Armando Faa ◽  
Gavino Faa ◽  
Apostolos Papalois ◽  
Eleonora Obinu ◽  
Giorgia Locci ◽  
...  
Keyword(s):  
Ventricular Fibrillation ◽  
Adrenal Glands ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Control Group ◽  
Swine Model ◽  
Protective Effects ◽  
Large White ◽  
Significant Difference

Aim.To evaluate the effects of erythropoietin administration on the adrenal glands in a swine model of ventricular fibrillation and resuscitation.Methods. Ventricular fibrillation was inducedviapacing wire forwarded into the right ventricle in 20 female Landrace/Large White pigs, allocated into 2 groups: experimental group treated with bolus dose of erythropoietin (EPO) and control group which received normal saline. Cardiopulmonary resuscitation (CPR) was performed immediately after drug administrationas perthe 2010 European Resuscitation Council (ERC) guidelines for Advanced Life Support (ALS) until return of spontaneous circulation (ROSC) or death. Animals who achieved ROSC were monitored, mechanically ventilated, extubated, observed, and euthanized. At necroscopy, adrenal glands samples were formalin-fixed, paraffin-embedded, and routinely processed. Sections were stained with hematoxylin-eosin.Results.Oedema and apoptosis were the most frequent histological changes and were detected in all animals in the adrenal cortex and in the medulla. Mild and focal endothelial lesions were also detected. A marked interindividual variability in the degree of the intensity of apoptosis and oedema at cortical and medullary level was observed within groups. Comparing the two groups, higher levels of pathological changes were detected in the control group. No significant difference between the two groups was observed regarding the endothelial changes.Conclusions. In animals exposed to ventricular fibrillation, EPO treatment has protective effects on the adrenal gland.

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