Epinephrine plus standard CPR resulted in a significantly higher proportion of return of spontaneous circulation compared to epinephrine alone (67% vs 15%, p=0.0007) in a porcine pseudo-PEA model.
RCT (n=12)
Does epinephrine plus CPR improve the probability of ROSC compared to epinephrine alone in a porcine model of hypoxia-induced pseudo-PEA?
In a preclinical porcine model of pseudo-PEA, the addition of chest compressions to epinephrine significantly improved intra-arrest hemodynamics and the probability of achieving ROSC compared to epinephrine alone.
Absolute Event Rate: 67% vs 15%
p-value: p=0.0007
Pseudo-pulseless electrical activity (pseudo-PEA) is a global hypotensive ischemic state with retained coordinated myocardial contractile activity and an organized ECG with no clinically detectable pulses. The role of standard external chest compressions (CPR) and its associated intrinsic hemodynamics remains unclear in the setting of pseudo-PEA. We undertook an experimental trial to compare epinephrine alone versus epinephrine with CPR in the treatment of pseudo-PEA. Using a porcine model of hypoxic pseudo-PEA, we randomized 12 Yorkshire male swine to resuscitation with epinephrine only (control) (0.0015 mg/kg) versus epinephrine plus standard CPR (intervention). Animals who achieved return of spontaneous circulation (ROSC) were stabilized, fully recovered to hemodynamic and respiratory baseline, and rearrested up to 6 times. Primary outcome was ROSC defined as a sustained systolic blood pressure (SBP) of 60 mmHg for 2 min. Secondary outcomes included time to ROSC, coronary perfusion pressure (CoPP), and end-tidal carbon dioxide (ETCO2). Among 47 events of pseudo-PEA in 12 animals, we observed significantly higher proportion of ROSC when treatment included CPR (14/21 – 67%) compared to epinephrine alone (4/26 – 15%) (p = 0.0007). CoPP, aortic pressures and ETCO2 were significantly higher, and right atrial pressures were lower in the intervention group. In a swine model of hypoxia-induced pseudo-PEA, epinephrine plus CPR was associated with improved intra-arrest hemodynamics and higher probability of ROSC. Thus, epinephrine plus CPR may be superior to epinephrine alone in the treatment of patients with pseudo-PEA.
Teran et al. (Fri,) conducted a rct in Hypoxia-induced pseudo-pulseless electrical activity (pseudo-PEA) (n=12). Epinephrine plus standard CPR vs. Epinephrine only was evaluated on Return of spontaneous circulation (ROSC) defined as a sustained systolic blood pressure (SBP) of 60 mmHg for 2 min (p=0.0007). Epinephrine plus standard CPR resulted in a significantly higher proportion of return of spontaneous circulation compared to epinephrine alone (67% vs 15%, p=0.0007) in a porcine pseudo-PEA model.