In-hospital Cardiopulmonary Resuscitation during Asystole: Discussion
Survival statistics for CPR at NSUH during the study period are virtually identical to those reported by other institutions during the current decade. It has been suggested that the persistent low survival rates may be due to the increased use of CPR in patients who in the past would not have undergone such treatment. As a result, improvements in treatment methods and procedures may not be reflected in overall survival statistics. On the other hand, the constancy in results may reflect a lack of critical analysis and changes in therapeutic modalities. The study reported here attempted to address some of these issues by focusing on arrests characterized by an initial rhythm of asystole and evaluating the relative efficacy of various therapies. In doing so, we isolated a group of patients in whom the prognosis for resuscitation is particularly poor and identified therapeutic correlates of improved outcome. canadian neighbor pharmacy com
Data analyses revealed that CPR outcome was independent of most variables studied. However, the use of norepinephrine and lidocaine drips, particularly in combination, was associated with improved 24-h survival, while the use of a pacemaker was associated with decreased survival. Since the AHA recommends the use of epinephrine and atropine for asystole and makes no mention of norepinephrine or lidocaine, it was of interest to examine the utility of these drugs when used alone and in combination with norepinephrine and lidocaine drips. We found that the addition of norepinephrine and lidocaine drips to the AHA-recommended sequence of epinephrine and atropine improved survival substantially. In interpreting these results, it must be kept in mind that this combination and sequence of treatments was not followed in the majority of cases and was not under any kind of experimental control.
When lidocaine was used, it was done to decrease ventricular irritability presumably caused by the earlier administration of epinephrine and/or norepinephrine. It is important to note that in cases where neither norepinephrine nor lidocaine drips were used, the duration of CPR efforts was considerably shorter. Nevertheless, the results suggest a need to further study the differential efficacy of these treatment combinations, and lead to pharmacologic hypotheses concerning the possible mechanisms underlying these effects. Norepinephrine is a potent a and P receptor agonist which increases myocardial irritability and serves as a positive inotropic and chronotropic agent. Administration of this agent to patients by IV infusion results in a powerful peripheral vasoconstriction of both arterial and venous beds secondary to the a activity.