Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest

Patrick J McNamara; Doreen Engelberts; Michael Finelli; Khosrow Adeli; Brian P Kavanagh

doi:10.1038/pr.2014.38

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Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest

Journal article

Open access

Peer reviewed

Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest

Patrick J McNamara, Doreen Engelberts, Michael Finelli, Khosrow Adeli and Brian P Kavanagh

Pediatric research, Vol.75(6), pp.738-748

06/2014

DOI: 10.1038/pr.2014.38

PMID: 24614799

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Abstract

Epinephrine is a component of all resuscitation algorithms. Vasopressin is a pulmonary vasodilator and systemic vasopressor. We investigated the effect of epinephrine vs. vasopressin on survival and hemodynamics after neonatal porcine cardiac arrest (CA). A 4-min asphyxial CA was induced, after which cardiopulmonary resuscitation (CPR) was commenced. Animals were randomized to low- (LDE: 0.01 mg/kg) or high-dose epinephrine (HDE: 0.03 mg/kg), low- (LDV: 0.2 U/kg) or high-dose vasopressin (HDV: 0.4 U/kg), or control (saline). Clinical and echocardiography indexes were monitored. Sixty-nine animals were randomized. Survival was greater in HDV (n = 8 (89%); P < 0.05 ANOVA) vs. control (n = 7 (43%)) and LDE (n = 5 (36%)) but not vs. HDE (n = 7 (64%)) or LDV (n = 6 (75%)). Animals resuscitated with LDE required more shocks (2.5 (interquartile range: 2-6); P < 0.05) and higher doses of energy (15 J (interquartile range: 10-20); P < 0.05). Left ventricular output was comparable between groups, but a greater increase in superior vena caval flow was seen after HDV (P < 0.001 vs. control, LDE, and HDE). Plasma troponin was greatest in the HDE group (P < 0.05 vs. control and HDV). Vasopressin results in improved survival, lower postresuscitation troponin, and less hemodynamic compromise after CA in newborn piglets. Vasopressin may be a candidate for testing in human neonates.

Animals, Newborn

Cardiopulmonary Resuscitation - methods

Echocardiography

Vasopressins - therapeutic use

Vasopressins - pharmacology

Treatment Outcome

Dose-Response Relationship, Drug

Heart Arrest - drug therapy

Animals

Analysis of Variance

Epinephrine - therapeutic use

Swine

Troponin - blood

Epinephrine - pharmacology

Details

Title: Subtitle: Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest
Creators: Patrick J McNamara - 1] Division of Neonatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Physiology and Experimental Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
Doreen Engelberts - Physiology and Experimental Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
Michael Finelli - Department of Respiratory Therapy, Hospital for Sick Children, Toronto, Ontario, Canada
Khosrow Adeli - Division of Clinical Biochemistry, Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
Brian P Kavanagh - Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Resource Type: Journal article
Publication Details: Pediatric research, Vol.75(6), pp.738-748
DOI: 10.1038/pr.2014.38
PMID: 24614799
ISSN: 0031-3998
eISSN: 1530-0447
Language: English
Date published: 06/2014
Academic Unit: Stead Family Department of Pediatrics; Neonatology; Internal Medicine
Record Identifier: 9984093597502771

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