Blood gas parameters during cardio-pulmonary resuscitation in a post hoc analysis-porcine study with data pooled from two studies: increased acidosis with repeated adrenaline injections compared to a control group during prolonged advanced life support

IF 3.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2026-09-01 Epub Date: 2026-08-24 DOI:10.1016/j.resplu.2026.101459

Felicia Feurstein, Adam Åkerman, Jakob Lundager Forberg, Jan Belohlavek, Mikuláš Mlček, Carl-David Dolata, Henrik Wagner

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Abstract

Background

Cardiopulmonary resuscitation (CPR) guidelines recommend an injection of 1 mg of adrenaline every 3–5 min in a cardiac arrest situation. Adrenaline increases return of spontaneous circulation (ROSC) and induces a more acidotic state in cardiac arrest situations. Blood gas analysis is a useful tool to assess the metabolic state during CPR.

Most experimental studies have been conducted with a single injection of adrenaline. However, little is known about how blood gas parameters are affected by repeated adrenaline injections during prolonged CPR.

Methods

This was a pooled post-hoc analysis from two studies, in which repeated injections of adrenaline and saline as a control were administered during 16- or 21-min of CPR according to current guidelines. Sixty pigs were induced with cardiac arrest, randomised to either adrenaline or saline. Arterial blood gases were drawn at baseline, after the second and fourth injection of adrenaline/saline, and after 5 and 10 min of ROSC. The analysis included pH, Base excess, Bicarbonate, lactate, partial pressure of carbon dioxide, partial pressure of oxygen, oxygen saturation, haemoglobin, and potassium.

Results

Sixteen/twenty-four animals (66.7%) obtained ROSC in the control group and 17/36(47.2%) in the adrenaline group (ns). Adrenaline resulted in significantly lower pH, base excess, and bicarbonate higher lactate, carbon dioxide, haemoglobin and potassium, compared to a control-group among animals that achieved ROSC, but not in non-ROSC groups.

Conclusion

Repeated adrenaline injections was associated with a more acidotic profile and higher potassium and haemoglobin levels in animals that achieved ROSC during prolonged CPR compared with the control-group. However, this was not seen in the non-ROSC groups.

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肺动脉复苏期间的血气参数，数据来源于两项研究：与对照组相比，在延长的晚期生命支持期间，反复注射肾上腺素增加了酸中毒

背景：心肺复苏（CPR）指南建议在心脏骤停情况下每3-5分钟注射1毫克肾上腺素。肾上腺素增加了自发循环（ROSC）的恢复，并在心脏骤停的情况下诱发了更酸中毒的状态。血气分析是评估心肺复苏术中代谢状态的有用工具。大多数实验研究都是通过单次注射肾上腺素进行的。然而，在长时间心肺复苏术中反复注射肾上腺素对血气参数的影响尚不清楚。方法：本研究对两项研究的事后分析进行汇总，在这两项研究中，根据目前的指导方针，在CPR的16或21分钟期间反复注射肾上腺素和生理盐水作为对照。60头猪被诱导心脏骤停，随机分为肾上腺素组和生理盐水组。在基线、第二次和第四次肾上腺素/生理盐水注射后、ROSC 5和10分钟后，采集动脉血气。分析包括pH值、碱过量、碳酸氢盐、乳酸、二氧化碳分压、氧气分压、氧饱和度、血红蛋白和钾。结果对照组有16只（66.7%）出现ROSC，肾上腺素组有17只（47.2%）出现ROSC。在达到ROSC的动物中，与对照组相比，肾上腺素导致pH值显著降低，碱过量，碳酸氢盐升高乳酸，二氧化碳，血红蛋白和钾，但在非ROSC组中没有。结论与对照组相比，在延长CPR期间达到ROSC的动物中，重复肾上腺素注射与更多的酸中毒特征、更高的钾和血红蛋白水平相关。然而，在非rosc组中没有看到这种情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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