FUTURE-DIRECTIONS FOR RESUSCITATION RESEARCH .4. INNOVATIVE ADVANCED LIFE-SUPPORT PHARMACOLOGY

The topics discussed in this session include a partial review of labor atory and clinical studies examining the effects of adrenergic agonist s on restoration of spontaneous circulation after cardiac arrest, the effects of varying doses of epinephrine, and the effects of novel vaso pressors, buffer agents (NaHCO3, THAM, 'Carbicarb') and anti-arrhythmi cs (lidocaine, bretylium, amiodarone) in refractory ventricular fibril lation. Novel therapeutic approaches include titrating electric counte rshocks against electrocardiographic power spectra and of preceding th e first countershocks with single or multiple drug treatments. These a pproaches need to be investigated further in controlled animal and pat ient studies. Epidemiologic data from randomized clinical outcome stud ies can give clues, but cannot document pharmacologic mechanisms in th e dynamically changing events during attempts to achieve restoration o f spontaneous circulation from prolonged cardiac arrest. Also, rapid d rug administration by the intraosseous route was compared with intratr acheal and intravenous (i.v.) drug administration. Many studies on the above treatments have yielded conflicting results because of differen ces between healthy hearts of animals and sick hearts of patients, dif ferences in arrest (no-flow) times and cardiopulmonary resuscitation ( CPR) (low-flow) times, different pharmacokinetics, different dose/resp onse requirements, and different timing of drug administration during low-flow CPR versus during spontaneous circulation. The need to stabil ize normotension and prevent rearrest by titrated novel drug administr ation, once spontaneous circulation has been restored, requires resear ch. Most of the above topics require some re-evaluation in clinically realistic animal models and in cardiac arrest patients, especially by titration of old and new drug treatments against variables that can be monitored continuously during resuscitation. Copyright (C) 1996 Elsev ier Science Ireland Ltd