Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest

Bibliographic Data

ID15713183
AuthorsDeepika Sankaran (0000-0002-6704-6949, University of California, Davis, corresponding author), Payam Vali (0000-0001-9270-8118, University of California, Davis), Praveen Chandrasekharan (0000-0001-8727-3017, University at Buffalo, State University of New York), Peggy Chen (University of California, Davis), Sylvia F Gugino (University at Buffalo, State University of New York), Carmon Koenigsknecht (University at Buffalo, State University of New York), Justin Helman (University at Buffalo, State University of New York), Jayasree Nair (0000-0003-3846-2027, University at Buffalo, State University of New York), Bobby Mathew (University at Buffalo, State University of New York), Munmun Rawat (0000-0001-9703-9857, University at Buffalo, State University of New York), Lori Nielsen (University at Buffalo, State University of New York), Amy Lesneski (University of California, Davis), Morgan Hardie (University of California, Davis), Ziad Alhassen (0000-0001-6734-253X, University of California, Davis), Houssam M Joudi (University of California, Davis), Evan Giusto (0000-0003-0364-0057, University of California, Davis), Lida Zeinali (University at Buffalo, State University of New York), Heather K Knych (0000-0002-8676-4970, University of California, Davis), Gary M Weiner (0000-0002-9026-6149, University of Michigan), Satyan Lakshminrusimha (0000-0001-6098-2155, University of California, Davis)
Year2021
Volume8
Issue6
Pages464-464
Publication date2021-05-31
Open AccessYes
TypeARTICLE
VenueChildren (JOURNAL)
Journal identifiersISSN: 2227-9067 • E-ISSN: 2227-9067
PublisherMultidisciplinary Digital Publishing Institute (PUBLISHER • CH)
DOI10.3390/children8060464
PMID34205843
OpenAlexW3166603803
LanguageEN
Citations received3

The 7th edition of the Textbook of Neonatal Resuscitation recommends administration of epinephrine via an umbilical venous catheter (UVC) inserted 2-4 cm below the skin, followed by a 0.5-mL to 1-mL flush for severe bradycardia despite effective ventilation and chest compressions (CC). This volume of flush may not be adequate to push epinephrine to the right atrium in the absence of intrinsic cardiac activity during CC. The objective of our study was to evaluate the effect of 1-mL and 2.5-mL flush volumes after UVC epinephrine administration on the incidence and time to achieve return of spontaneous circulation (ROSC) in a near-term ovine model of perinatal asphyxia induced cardiac arrest. After 5 min of asystole, lambs were resuscitated per Neonatal Resuscitation Program (NRP) guidelines. During resuscitation, lambs received epinephrine through a UVC followed by 1-mL or 2.5-mL normal saline flush. Hemodynamics and plasma epinephrine concentrations were monitored. Three out of seven (43%) and 12/15 (80%) lambs achieved ROSC after the first dose of epinephrine with 1-mL and 2.5-mL flush respectively ( p = 0.08). Median time to ROSC and cumulative epinephrine dose required were not different. Plasma epinephrine concentrations at 1 min after epinephrine administration were not different. From our pilot study, higher flush volume after first dose of epinephrine may be of benefit during neonatal resuscitation. More translational and clinical trials are needed

Anesthesia · Asphyxia · Asystole · Cardiopulmonary resuscitation · Epinephrine · Neonatal resuscitation · Resuscitation · Return of spontaneous circulation · Saline · Airway Management and Intubation Techniques · Cardiac Arrest and Resuscitation · Medicine · Neonatal Respiratory Health Research

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