Search tips
Search criteria 


Logo of heartHeartVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Heart. 1996 February; 75(2): 145–150.
PMCID: PMC484250

Release of endogenous vasopressors during and after cardiopulmonary resuscitation.


OBJECTIVE: To assess whether plasma endothelin, adrenaline, noradrenaline, arginine vasopressin, adrenocorticotropin, and cortisol concentrations were higher during cardiopulmonary resuscitation in patients in whom resuscitation was successful than in those in whom it failed, and to measure the concentrations of these hormones in the immediate post-resuscitation phase. DESIGN: Prospective, descriptive study. SETTING: Emergency medical service at a university hospital. PATIENTS: 60 patients with cardiac arrest out of hospital. INTERVENTIONS: Blood samples were drawn and blood pressure and heart rate were measured during cardiopulmonary resuscitation, before and after the first dose of adrenaline was given and at 5, 15, 30, and 60 minutes after the restoration of spontaneous circulation. Plasma hormone concentrations were measured by radio-immunoassays. RESULTS: 24 of the 60 patients were successfully resuscitated and admitted to hospital: 36 were not. During cardiopulmonary resuscitation before adrenaline was given, the plasma concentration of endothelin (mean (SEM)) in resuscitated and in not resuscitated patients was 4.3 (0.9) pg/ml and 5.5 (0.4) pg/ml respectively (NS), adrenaline was 14.1 (2.0) ng/ml and 25.3 (3.6) ng/ml (P < 0.01), noradrenaline was 5.0 (0.9 ng/ml) and 8.4 (1.1 ng/ml) (P < 0.05), arginine vasopressin was 193 (28) pg/ml and 70 (9) pg/ml (P < 0.001), adrenocorticotropin was 128 (34) pg/ml and 57 (6) pg/ml (P < 0.05), and cortisol was 18 (3) microgram/dl and 15 (2) microgram/dl (NS). During cardiopulmonary resuscitation after adrenaline was given endothelin in resuscitated and in not resuscitated patients was 4.0 (1.0) pg/ml and 5.3 (0.5) pg/ml (NS), adrenaline was 145 (16) ng/ml and 201 (21) ng/ml (P < 0.05), noradrenaline was 3.9 (0.9) ng/ml and 8.3 (1.1) ng/ml (P < 0.01), arginine vasopressin was 177 (27) pg/ml and 58 (9) pg/ml (P < 0.001), adrenocorticotropin was 234 (92) pg/ml and 85 (9) pg/ml (P < 0.001), and cortisol was 17 (2) microgram/dl and 13 (2) microgram/dl (NS). CONCLUSIONS: Despite a tremendous adrenosympathetic response, the lower arginine vasopressin and adrenocorticotropin concentrations during cardiopulmonary resuscitation in patients in whom resuscitation failed may influence vital organ perfusion and hence the success of resuscitation. Plasma concentrations of arginine vasopressin and adrenocorticotropin may have a more important effect on outcome than previously thought.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Lindner KH, Strohmenger HU, Prengel AW, Ensinger H, Goertz A, Weichel T. Hemodynamic and metabolic effects of epinephrine during cardiopulmonary resuscitation in a pig model. Crit Care Med. 1992 Jul;20(7):1020–1026. [PubMed]
  • Prengel AW, Lindner KH, Ensinger H, Grünert A. Plasma catecholamine concentrations after successful resuscitation in patients. Crit Care Med. 1992 May;20(5):609–614. [PubMed]
  • Shen YT, Cowley AW, Jr, Vatner SF. Relative roles of cardiac and arterial baroreceptors in vasopressin regulation during hemorrhage in conscious dogs. Circ Res. 1991 May;68(5):1422–1436. [PubMed]
  • Wilson MF, Brackett DJ. Release of vasoactive hormones and circulatory changes in shock. Circ Shock. 1983;11(3):225–234. [PubMed]
  • Miller RC, Pelton JT, Huggins JP. Endothelins--from receptors to medicine. Trends Pharmacol Sci. 1993 Feb;14(2):54–60. [PubMed]
  • Haak T, Jungmann E, Felber A, Hillmann U, Usadel KH. Increased plasma levels of endothelin in diabetic patients with hypertension. Am J Hypertens. 1992 Mar;5(3):161–166. [PubMed]
  • Remuzzi G, Benigni A. Endothelins in the control of cardiovascular and renal function. Lancet. 1993 Sep 4;342(8871):589–593. [PubMed]
  • Masaki T. Endothelins: homeostatic and compensatory actions in the circulatory and endocrine systems. Endocr Rev. 1993 Jun;14(3):256–268. [PubMed]
  • Ota K, Kimura T, Shoji M, Inoue M, Sato K, Ohta M, Yamamoto T, Tsunoda K, Abe K, Yoshinaga K. Interaction of ANP with endothelin on cardiovascular, renal, and endocrine function. Am J Physiol. 1992 Feb;262(2 Pt 1):E135–E141. [PubMed]
  • Kaufmann H, Oribe E, Oliver JA. Plasma endothelin during upright tilt: relevance for orthostatic hypotension? Lancet. 1991 Dec 21;338(8782-8783):1542–1545. [PubMed]
  • Schultz CH, Rivers EP, Feldkamp CS, Goad EG, Smithline HA, Martin GB, Fath JJ, Wortsman J, Nowak RM. A characterization of hypothalamic-pituitary-adrenal axis function during and after human cardiac arrest. Crit Care Med. 1993 Sep;21(9):1339–1347. [PubMed]
  • Lindner KH, Ahnefeld FW, Bowdler IM, Prengel AW. Influence of epinephrine on systemic, myocardial, and cerebral acid-base status during cardiopulmonary resuscitation. Anesthesiology. 1991 Feb;74(2):333–339. [PubMed]
  • Wortsman J, Frank S, Cryer PE. Adrenomedullary response to maximal stress in humans. Am J Med. 1984 Nov;77(5):779–784. [PubMed]
  • Brown CG, Martin DR, Pepe PE, Stueven H, Cummins RO, Gonzalez E, Jastremski M. A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. The Multicenter High-Dose Epinephrine Study Group. N Engl J Med. 1992 Oct 8;327(15):1051–1055. [PubMed]
  • Tilders FJ, Berkenbosch F, Vermes I, Linton EA, Smelik PG. Role of epinephrine and vasopressin in the control of the pituitary-adrenal response to stress. Fed Proc. 1985 Jan;44(1 Pt 2):155–160. [PubMed]
  • Lindner KH, Brinkmann A, Pfenninger EG, Lurie KG, Goertz A, Lindner IM. Effect of vasopressin on hemodynamic variables, organ blood flow, and acid-base status in a pig model of cardiopulmonary resuscitation. Anesth Analg. 1993 Sep;77(3):427–435. [PubMed]
  • Lindner KH, Prengel AW, Pfenninger EG, Lindner IM, Strohmenger HU, Georgieff M, Lurie KG. Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs. Circulation. 1995 Jan 1;91(1):215–221. [PubMed]

Articles from Heart are provided here courtesy of BMJ Group