111 Epinephrine Causes Lethal Cardiac Dysfunction in Cardiopulmonary Resuscitation which is Reversed by Calcium Channel Blockade
Bibliographic record
Abstract
Epinephrine is recommended during cardiopulmonary resuscitation, but amplifies cardiac depression following ventricular fibrillation. In pediatric practice, cardiac arrest is almost always due to asphyxia, and while the effects of catecholamines are unknown, their use is ubiquitous. [1] to characterize the myocardial effects of epinephrine following asphyxial cardiac arrest; and [2] to investigate the physiologic/biochemical mechanisms of dysfunction. Sprague-Dawley rats (350–400 g) were anaesthetized and exposed to one-minute asphyxial cardiac arrest. Standardized resuscitation was attempted with mechanical ventilation (FiO2 1.0), chest compressions and intravenous medication. Three experimental series were completed. The effects of epinephrine (10 or 30 μg/kg) vs. control (saline) were examined using non-invasive ECHO (Series #1), and by direct (open chest) measurement of left atrial pressure (PLA) (Series #2). The impact of calcium channel blockade (verapamil 0.1 mg/kg) on epinephrine induced effects (30 μg/kg) was also evaluated by ECHO (Series #3). Monitoring comprised serial transthoracic echocardiography (shortening fraction-LVSF; end-diastolic diameter-LVEDD), invasive systemic arterial pressure and blood gas analysis at baseline and up to 2 h post-resuscitation. Epinephrine increased mortality, and caused a dose-dependent decrease in diastolic function (reduced LVEDD; Fig. 1). The diastolic dysfunction was associated with increased PLA (P<0.05) and myocardial hypercontraction. Finally, verapamil eliminated epinephrine-induced mortality (P<0.002), and attenuated the diastolic dysfunction (P<0.05). Epinephrine administration for CPR following asphyxial cardiac arrest is associated with dose-dependent diastolic dysfunction, left atrial hypertension and increased mortality. These effects are attenuated by calcium channel blockade. This data provides mechanistic insight and points to potential therapeutic approaches in pediatric cardiac arrest.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".