The roles of methoxamine and norepinephrine in electromechanical dissociation

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Electromechanical dissociation (EMD) in patients in cardiac arrest is associated with a poor prognosis. Pressor agents, particularly alpha-agonists, have proven to be useful in resuscitation from asphyxial and fibrillatory arrest in the animal model. Beta-agonists, such as isoproterenol, have not been shown to improve the resuscitation rate. The standard pressor used in all forms of cardiac arrest is epinephrine. The key question that must be considered is whether methoxamine or norepinephrine is superior to epinephrine in resuscitating patients in cardiac arrest. Methoxamine is a pure alpha 1 agonist causing vasoconstriction and increased peripheral vascular resistance. Norepinephrine and epinephrine demonstrate activity at alpha 1, alpha 2, beta 1, and beta 2 receptor sites. Does alpha 2 and beta activity help or hinder resuscitation? Beta activity on the myocardium will increase oxygen consumption (inotropic and chronotropic effects), may predispose to arrhythmias, and will shunt blood from the endocardium to the epicardium. On the other hand, there is evidence that beta agonists increase coronary and cerebral blood flow. Outcome studies have shown methoxamine to be comparable to epinephrine in resuscitation from asphyxial arrest. One study demonstrated methoxamine's superiority in raising the aortic diastolic pressure and resuscitating animals from ventricular fibrillation. No significant advantage of norepinephrine use is evident in the literature. Controlled experiments in the animal model and in human patients must be done to determine whether methoxamine or epinephrine is superior in resuscitation from EMD and other forms of cardiac arrest.

Original languageEnglish (US)
Pages (from-to)835-839
Number of pages5
JournalAnnals of Emergency Medicine
Volume13
Issue number9 PART 2
DOIs
StatePublished - 1984

Fingerprint

Methoxamine
Resuscitation
Epinephrine
Norepinephrine
Heart Arrest
Vascular Resistance
Cerebrovascular Circulation
Animal Models
Endocardium
Pericardium
Ventricular Fibrillation
Vasoconstriction
Isoproterenol
Oxygen Consumption
Cardiac Arrhythmias
Myocardium
Arterial Pressure
Outcome Assessment (Health Care)
Blood Pressure

Keywords

  • cardiopulmonary resuscitation
  • electromechanical dissociation
  • methoxamine
  • norepinephrine

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

The roles of methoxamine and norepinephrine in electromechanical dissociation. / Sanders, Arthur B.

In: Annals of Emergency Medicine, Vol. 13, No. 9 PART 2, 1984, p. 835-839.

Research output: Contribution to journalArticle

@article{a31cdf27ba004a28b2f29d75fd7887c5,
title = "The roles of methoxamine and norepinephrine in electromechanical dissociation",
abstract = "Electromechanical dissociation (EMD) in patients in cardiac arrest is associated with a poor prognosis. Pressor agents, particularly alpha-agonists, have proven to be useful in resuscitation from asphyxial and fibrillatory arrest in the animal model. Beta-agonists, such as isoproterenol, have not been shown to improve the resuscitation rate. The standard pressor used in all forms of cardiac arrest is epinephrine. The key question that must be considered is whether methoxamine or norepinephrine is superior to epinephrine in resuscitating patients in cardiac arrest. Methoxamine is a pure alpha 1 agonist causing vasoconstriction and increased peripheral vascular resistance. Norepinephrine and epinephrine demonstrate activity at alpha 1, alpha 2, beta 1, and beta 2 receptor sites. Does alpha 2 and beta activity help or hinder resuscitation? Beta activity on the myocardium will increase oxygen consumption (inotropic and chronotropic effects), may predispose to arrhythmias, and will shunt blood from the endocardium to the epicardium. On the other hand, there is evidence that beta agonists increase coronary and cerebral blood flow. Outcome studies have shown methoxamine to be comparable to epinephrine in resuscitation from asphyxial arrest. One study demonstrated methoxamine's superiority in raising the aortic diastolic pressure and resuscitating animals from ventricular fibrillation. No significant advantage of norepinephrine use is evident in the literature. Controlled experiments in the animal model and in human patients must be done to determine whether methoxamine or epinephrine is superior in resuscitation from EMD and other forms of cardiac arrest.",
keywords = "cardiopulmonary resuscitation, electromechanical dissociation, methoxamine, norepinephrine",
author = "Sanders, {Arthur B}",
year = "1984",
doi = "10.1016/S0196-0644(84)80454-0",
language = "English (US)",
volume = "13",
pages = "835--839",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "9 PART 2",

}

TY - JOUR

T1 - The roles of methoxamine and norepinephrine in electromechanical dissociation

AU - Sanders, Arthur B

PY - 1984

Y1 - 1984

N2 - Electromechanical dissociation (EMD) in patients in cardiac arrest is associated with a poor prognosis. Pressor agents, particularly alpha-agonists, have proven to be useful in resuscitation from asphyxial and fibrillatory arrest in the animal model. Beta-agonists, such as isoproterenol, have not been shown to improve the resuscitation rate. The standard pressor used in all forms of cardiac arrest is epinephrine. The key question that must be considered is whether methoxamine or norepinephrine is superior to epinephrine in resuscitating patients in cardiac arrest. Methoxamine is a pure alpha 1 agonist causing vasoconstriction and increased peripheral vascular resistance. Norepinephrine and epinephrine demonstrate activity at alpha 1, alpha 2, beta 1, and beta 2 receptor sites. Does alpha 2 and beta activity help or hinder resuscitation? Beta activity on the myocardium will increase oxygen consumption (inotropic and chronotropic effects), may predispose to arrhythmias, and will shunt blood from the endocardium to the epicardium. On the other hand, there is evidence that beta agonists increase coronary and cerebral blood flow. Outcome studies have shown methoxamine to be comparable to epinephrine in resuscitation from asphyxial arrest. One study demonstrated methoxamine's superiority in raising the aortic diastolic pressure and resuscitating animals from ventricular fibrillation. No significant advantage of norepinephrine use is evident in the literature. Controlled experiments in the animal model and in human patients must be done to determine whether methoxamine or epinephrine is superior in resuscitation from EMD and other forms of cardiac arrest.

AB - Electromechanical dissociation (EMD) in patients in cardiac arrest is associated with a poor prognosis. Pressor agents, particularly alpha-agonists, have proven to be useful in resuscitation from asphyxial and fibrillatory arrest in the animal model. Beta-agonists, such as isoproterenol, have not been shown to improve the resuscitation rate. The standard pressor used in all forms of cardiac arrest is epinephrine. The key question that must be considered is whether methoxamine or norepinephrine is superior to epinephrine in resuscitating patients in cardiac arrest. Methoxamine is a pure alpha 1 agonist causing vasoconstriction and increased peripheral vascular resistance. Norepinephrine and epinephrine demonstrate activity at alpha 1, alpha 2, beta 1, and beta 2 receptor sites. Does alpha 2 and beta activity help or hinder resuscitation? Beta activity on the myocardium will increase oxygen consumption (inotropic and chronotropic effects), may predispose to arrhythmias, and will shunt blood from the endocardium to the epicardium. On the other hand, there is evidence that beta agonists increase coronary and cerebral blood flow. Outcome studies have shown methoxamine to be comparable to epinephrine in resuscitation from asphyxial arrest. One study demonstrated methoxamine's superiority in raising the aortic diastolic pressure and resuscitating animals from ventricular fibrillation. No significant advantage of norepinephrine use is evident in the literature. Controlled experiments in the animal model and in human patients must be done to determine whether methoxamine or epinephrine is superior in resuscitation from EMD and other forms of cardiac arrest.

KW - cardiopulmonary resuscitation

KW - electromechanical dissociation

KW - methoxamine

KW - norepinephrine

UR - http://www.scopus.com/inward/record.url?scp=0021145876&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0021145876&partnerID=8YFLogxK

U2 - 10.1016/S0196-0644(84)80454-0

DO - 10.1016/S0196-0644(84)80454-0

M3 - Article

C2 - 6476551

AN - SCOPUS:0021145876

VL - 13

SP - 835

EP - 839

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 9 PART 2

ER -