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Phenylephrine plus propranolol improves the balance between myocardial oxygen supply and demand during experimental cardiopulmonary resuscitation.

Abstract：

:Epinephrine increases coronary blood flow but may not improve the balance between myocardial oxygen supply and demand during cardiopulmonary resuscitation (CPR). The objective of this study was to determine whether this balance can be improved by administering a relatively pure alpha-adrenergic vasoconstrictor, alone or in combination with a beta-adrenergic blocker. We measured coronary perfusion pressures during CPR and myocardial adenosine 5'-triphosphate (ATP) and lactate concentrations in biopsies obtained immediately after 10 minutes of CPR in six control dogs and in three groups of six dogs each given large doses of epinephrine, phenylephrine, or phenylephrine plus propranolol during CPR. Coronary perfusion pressure during CPR was higher in the three treated groups than in the control group, although differences were limited to the early portion of CPR in dogs given epinephrine or phenylephrine alone. Postresuscitation myocardial ATP concentration was significantly higher (29.5 +/- 3.0 vs 22.6 +/- 1.8 nmol/mg of protein, p < 0.05) and myocardial lactate concentration tended to be lower (52.8 +/- 13.6 vs 78.5 +/- 15.2 nmol/mg of protein) than in the control group in dogs given both phenylephrine and propranolol. In contrast, myocardial ATP concentration tended to be lower than in the control group in epinephrine-treated dogs, and myocardial lactate concentrations were higher than in the control group in dogs treated with either epinephrine (p < 0.05) or phenylephrine alone (p = 0.052). We conclude that the balance between myocardial oxygen supply and demand during CPR can be improved by administering a combination of phenylephrine and propranolol, but not by administering large doses of epinephrine or phenylephrine alone.

journal_name

Am Heart J

journal_title

American heart journal

authors

Ditchey RV,Slinker BK

doi

10.1016/0002-8703(94)90120-1

subject

Has Abstract

pub_date

1994-02-01 00:00:00

pages

324-30

issue

eissn

0002-8703

issn

1097-6744

pii

0002-8703(94)90120-1

journal_volume

127

pub_type

杂志文章

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Phenylephrine plus propranolol improves the balance between myocardial oxygen supply and demand during experimental cardiopulmonary resuscitation.