Adrenaline increases blood-brain-barrier permeability after haemorrhagic cardiac arrest in immature pigs

作者：Semenas E^*; Sharma H S; Wiklund L

来源：Acta Anaesthesiologica Scandinavica, 2014, 58(5): 620-629.

DOI：10.1111/aas.12293

BackgroundAdrenaline (ADR) and vasopressin (VAS) are used as vasopressors during cardiopulmonary resuscitation. Data regarding their effects on blood-brain barrier (BBB) integrity and neuronal damage are lacking. We hypothesised that VAS given during cardiopulmonary resuscitation (CPR) after haemorrhagic circulatory arrest will preserve BBB integrity better than ADR.
MethodsTwenty-one anaesthetised sexually immature male piglets (with a weight of 24.31.3kg) were bled 35% via femoral artery to a mean arterial blood pressure of 25mmHg in the period of 15min. Afterwards, the piglets were subjected to 8min of untreated ventricular fibrillation followed by 15min of open-chest CPR. At 9min of circulatory arrest, piglets received amiodarone 1.0mg/kg and hypertonic-hyperoncotic solution 4ml/kg infusions for 20min. At the same time, VAS 0.4U/kg was given intravenously to the VAS group (n=9) while the ADR group received ADR 20g/kg (n=12). Internal defibrillation was attempted from 11min of cardiac arrest to achieve restoration of spontaneous circulation. The experiment was terminated 3h after resuscitation.
ResultsThe intracranial pressure (ICP) in the post-resuscitation phase was significantly greater in ADR group than in VAS group. VAS group piglets exhibited a significantly smaller BBB disruption compared with ADR group. Cerebral pressure reactivity index showed that cerebral blood flow autoregulation was also better preserved in VAS group.
ConclusionsResuscitation with ADR as compared with VAS after haemorrhagic circulatory arrest increased the ICP and impaired cerebrovascular autoregulation more profoundly, as well as exerted an increased BBB disruption though no significant difference in neuronal injury was observed.

• 出版日期2014-5