Effect of epinephrine administration interval on cerebral perfusion in a porcine cardiac arrest model

Ki Hong Kim; Ki Jeong Hong; Sang Do Shin; Kyoung Jun Song; Yoonjic Kim; Dong Hyun Choi; Jeong Ho Park; Tae Han Kim; Joo Jeong; Young Sun Ro; Hyun Jeong Kang

doi:10.1016/j.ajem.2025.01.019

Effect of epinephrine administration interval on cerebral perfusion in a porcine cardiac arrest model

Am J Emerg Med. 2025 Jan 9:90:81-87. doi: 10.1016/j.ajem.2025.01.019. Online ahead of print.

Authors

Ki Hong Kim¹, Ki Jeong Hong², Sang Do Shin¹, Kyoung Jun Song³, Yoonjic Kim⁴, Dong Hyun Choi⁵, Jeong Ho Park⁴, Tae Han Kim³, Joo Jeong⁶, Young Sun Ro⁴, Hyun Jeong Kang⁷

Affiliations

¹ Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
² Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University, Seoul, South Korea. Electronic address: [email protected].
³ Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
⁴ Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea.
⁵ Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
⁶ Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul, South Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
⁷ Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.

PMID: 39837105
DOI: 10.1016/j.ajem.2025.01.019

Abstract

Objectives: The recommended epinephrine administration interval during CPR is between 3 and 5 min. However, the optimal interval for improving cerebral perfusion remains controversial. This study aimed to evaluate the effects of epinephrine administration interval of 3 min or 5 min on cerebral perfusion pressure (CEPP) and cortical cerebral blood flow (CCBF) in a porcine cardiac arrest model.

Methods: An experimental model of ventricular fibrillation (VF) cardiac arrest was conducted using 26 pigs, randomised into 3-min and 5-min interval groups. Six minutes after VF induction, all pigs received 4 min of chest compressions, followed by 20 min of advanced cardiovascular life support, including defibrillation and intravenous epinephrine administration. CEPP and CCBF were measured simultaneously throughout the experiment.

Results: Each of the experimental groups comprised 13 pigs. The 3-min group showed higher CEPP compared with the 5-min group in between 16 min and 20 min, 26 min and 30 min from VF induction: mean (95 % Confidence intervals) 26.8 (4.7-49.0) mmHg for 3-min group and 11.3 (-5.7-28.3) mmHg for 5-min group in 18 to 20 min from VF induction, which showed biggest difference. No significant difference was observed in CCBF between the 3-min and 5-min groups throughout the resuscitation phase (from the first epinephrine administration): The relative ratios 6 to 8 min after VF induction ranged from 0.21 to 0.86 in the 3-min group, and 0.35 to 0.77 in the 5-min group.

Conclusion: The 3-min epinephrine administration interval showed a higher CEPP compared with the 5-min interval. No significant differences were found in the CCBF between the two interval groups.

Keywords: Animal experimentation; Cardiac arrest; Cerebral perfusion; Epinephrine; Swine.