Cardiac arrest was induced with asphyxia to identify if naloxone alone increases resuscitation rate during cardiopulmonary resuscitation in a rat asphyxia model. The animals were randomized into either a saline group (Sal-gro, treated with normal saline 1 ml iv, n = 8), a low-dose naloxone group (treated with naloxone 0.5 mg/kg iv, n = 8), or a high-dose naloxone group (HN-gro, treated with naloxone 1 mg/kg iv, n = 8) in a blinded fashion during resuscitation. At the end of 10 minutes of asphyxia, cardiopulmonary resuscitation was started, and each drug was administered at the same time. The rate of restoration of spontaneous circulation was seen in 1 of 8, 3 of 8, and 7 of 8 animals in the Sal-gro, LN-gro, and HN-gro, respectively. The rate of restoration of spontaneous circulation in HN-gro was significantly higher than that in Sal-gro (P < .05). Naloxone (1 mg/kg) alone can increase resuscitation rate following asphyxial cardiac arrest in rats.
"In the first one, 24 rats were randomized to receive saline (8 rats), low-dose naloxone (0.5 mg/kg IV—8 rats), or medium-dose naloxone (1 mg/kg—8 rats). The rate of ROSC was significantly higher and the recovery was significantly faster in the medium-dose naloxone group than in the saline group . However, the sample size was small and the study did not compare naloxone with other commonly used drugs, such as epinephrine or vasopressin. "
[Show abstract][Hide abstract] ABSTRACT: Although vasopressin has been reported to be more effective than epinephrine for cardiopulmonary resuscitation in ventricular fibrillation animal models, its efficacy in asphyxia model remains controversy. The purpose of this study was to investigate the effectiveness of vasopressin vs epinephrine on restoration of spontaneous circulation (ROSC) in a rabbit model of asphyxia cardiac arrest. Cardiac arrest was induced by clamping endotracheal tube. After 5 minutes of basic life-support cardiopulmonary resuscitation, animals who had no ROSC were randomly assigned to receive either epinephrine alone (epinephrine group; 200 microg/kg) or vasopressin alone (vasopressin group; 0.8 U/kg). The coronary perfusion pressure (CPP) was calculated as the difference between the minimal diastolic aortic and simultaneously recorded right atrial pressure. Restoration of spontaneous circulation was defined as an unassisted pulse with a systolic arterial pressure of 60 mm Hg or higher for 5 minutes or longer. We induced arrest in 62 rabbits, 15 of whom had ROSC before drug administration and were excluded from analysis. The remaining 47 rabbits were randomized to epinephrine group (n = 24) and vasopressin group (n = 23). Before and after drug administration, CPP in epinephrine group increased significantly (from -4 +/- 4 to 36 +/- 9 mm Hg at peak value, P = .000), whereas CPP in vasopressin group increased only slightly (from 9 +/- 5 to 18 +/- 6 mm Hg at peak value, P = .20). After drug administration, 13 of 24 epinephrine rabbit had ROSC, and only 2 of 23 vasopressin rabbit had ROSC (P < .01). Consequently, we conclude that epinephrine, but not vasopressin, increases survival rates in this adult rabbit asphyxia model.
The American journal of emergency medicine 07/2007; 25(5):509-14. DOI:10.1016/j.ajem.2006.08.022 · 1.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The following review intends to outline the unique aspects of providing cardiopulmonary resuscitation for the poisoned patient and highlights both current practice and new therapies that apply to toxicologic cases.
Although there are few prospective randomized studies to further evidence-based care of the poisoned patient, there have been several reports of novel uses of both established medications and new medications in toxicologic patients. These case reports highlight treatment possibilities and potential avenues for further research.
It is important for providers to recognize the limitations of standard advanced cardiac life support algorithms when caring for poisoned patients. Toxicologic causes of cardiopulmonary compromise should be considered along with administration of appropriate antidotes and adjunctive therapies.
Current opinion in critical care 07/2007; 13(3):287-93. DOI:10.1097/MCC.0b013e32814b040c · 2.62 Impact Factor
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