Comparison of epinephrine and vasopressin in a pediatric porcine model of asphyxial cardiac arrest

摘要

ObjectiveThis study was designed to compare the effects of vasopressin vs. epinephrine vs. the combination of epinephrine with vasopressin on vital organ blood flow and return of spontaneous circulation in a pediatric porcine model of asphyxial arrest.DesignProspective, randomized laboratory investigation using an established porcine model for measurement of hemodynamic variables, organ blood flow, blood gases, and return of spontaneous circulation.SettingUniversity hospital laboratory.SubjectsEighteen piglets weighing 8ndash;11 kg.InterventionsAsphyxial cardiac arrest was induced by clamping the endotracheal tube. After 8 mins of cardiac arrest and 8 mins of cardiopulmonary resuscitation, a bolus dose of either 0.8 units/kg vasopressin (n equals; 6), 200 mgr;g/kg epinephrine (n equals; 6), or a combination of 45 mgr;g/kg epinephrine with 0.8 units/kg vasopressin (n equals; 6) was administered in a randomized manner. Defibrillation was attempted 6 mins after drug administration.Measurements and Main ResultsMean plusmn; sem coronary perfusion pressure, before and 2 mins after drug administration, was 13 plusmn; 2 and 23 plusmn; 6 mm Hg in the vasopressin group; 14 plusmn; 2 and 31 plusmn; 4 mm Hg in the epinephrine group; and 13 plusmn; 1 and 33 plusmn; 6 mm Hg in the epinephrine-vasopressin group, respectively (pequals; NS). At the same time points, mean plusmn; sem left ventricular myocardial blood flow was 44 plusmn; 31 and 44 plusmn; 25 mLmiddot;minminus;1middot;100 gminus;1in the vasopressin group; 30 plusmn; 18 and 233 plusmn; 61 mLmiddot;minminus;1middot;100 gminus;1in the epinephrine group; and 36 plusmn; 10 and 142 plusmn; 57 mLmiddot;minminus;1middot;100 gminus;1in the epinephrine-vasopressin group (p .01 epinephrine vs. vasopressin;p .02 epinephrine-vasopressin vs. vasopressin). Total cerebral blood flow trended toward higher values after epinephrine-vasopressin (60 plusmn; 19 mLmiddot;minminus;1middot;100 gminus;1) than after vasopressin (36 plusmn; 17 mLmiddot;minminus;1middot;100 gminus;1) or epinephrine alone (31 plusmn; 7 mLmiddot;minminus;1middot;100 gminus;1;pequals; .07, respectively). One of six vasopressin, six of six epinephrine, and four of six epinephrine-vasopressin-treated animals had return of spontaneous circulation (p .01, vasopressin vs. epinephrine).ConclusionsAdministration of epinephrine, either alone or in combination with vasopressin, significantly improved left ventricular myocardial blood flow during cardiopulmonary resuscitation. Return of spontaneous circulation was significantly more likely in epinephrine-treated pigs than in animals resuscitated with vasopressin alone.