Comparative Resuscitation Measures for Drug Toxicities Utilizing Lipid Emulsions.

摘要

Purpose: The purpose was to determine the optimal combination of lipid rescue and traditional ACLS therapy for treatment overdose of bupivacaine, desipramine, venlafaxine and bupropion. Design: This study was a prospective, experimental, mixed research design Methods: For each drug studied, seven swine were assigned to eight ACLS or BLS protocol resuscitation groups: Vasopressin/Lipid; Epinephrine/Lipid; Lipid; Epinephrine; Vasopressin; Epinephrine/Vasopressin; Epinephrine/Lipid/Vasopressin; and CPR. Each subject was administered a toxic dose of the drug until there was a non-perfusing arrhythmia. Each resuscitation protocol was implemented. Survival was defined as return of spontaneous circulation to a systolic blood pressure 60 mm/Hg. Sample: The sample consisted of seven swine assigned to eight ACLS or BLS protocol resuscitation groups: Vasopressin/Lipid; Epinephrine/Lipid; Lipid; Epinephrine; Vasopressin; Epinephrine/Vasopressin; Epinephrine/Lipid/Vasopressin; and CPR. Analysis: An odds/ratio was used to analyze the data. Findings: As expected, the results varied according to the studied drug overdose. For example, with bupivacaine, seventy-one percent of the epinephrine/lipid group survived compared to 19% of all the groups without lipid therapy. The odds of survival for the epinephrine with lipids group was 8.5 fold greater than all the groups without lipid therapy. Epinephrine with lipid group had a five times greater odds for survival compared to epinephrine with vasopressin. Epinephrine alone offered a 4.5 times greater chance of survival when compared to the group that received lipid alone. No swine in the CPR or vasopressin group survived. With the desipramine study, 100% of the vasopressin group survived, whereas none of the epinephrine group survived (p>.05). Implications for Military Nursing: This research grant offers possible treatment options for those individuals that have received a lethal toxic dose of the four selected drugs.