Masked Randomized Trial of Epinephrine versus Vasopressin in an Ovine Model of Perinatal Cardiac Arrest

Bibliographic Data

ID15716684
AuthorsMunmun Rawat (0000-0001-9703-9857, University at Buffalo, State University of New York, corresponding author), Sylvia F Gugino (University at Buffalo, State University of New York), Sylvia Gugino (Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA), Carmon Koenigsknecht (University at Buffalo, State University of New York), Justin Helman (University at Buffalo, State University of New York), Lori Nielsen (University at Buffalo, State University of New York), Deepika Sankaran (0000-0002-6704-6949, University of California Davis Medical Center), Jayasree Nair (0000-0003-3846-2027, University at Buffalo, State University of New York), Praveen Chandrasekharan (0000-0001-8727-3017, University at Buffalo, State University of New York), Satyan Lakshminrusimha (0000-0001-6098-2155, University of California Davis Medical Center)
Year2023
Volume10
Issue2
Pages349-349
Publication date2023-02-10
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueChildren (JOURNAL)
Journal identifiersISSN: 2227-9067 • E-ISSN: 2227-9067
PublisherMultidisciplinary Digital Publishing Institute (PUBLISHER • CH)
DOI10.3390/children10020349
PMID36832479
OpenAlexW4319921250
LanguageEN
Citations received1
References cited33

Current neonatal resuscitation guidelines recommend the use of epinephrine for bradycardia/arrest not responding to ventilation and chest compressions. Vasopressin is a systemic vasoconstrictor and is more effective than epinephrine in postnatal piglets with cardiac arrest. There are no studies comparing vasopressin with epinephrine in newly born animal models with cardiac arrest induced by umbilical cord occlusion. Objective: To compare the effect of epinephrine and vasopressin on the incidence and time to return of spontaneous circulation (ROSC), hemodynamics, plasma drug levels, and vasoreactivity in perinatal cardiac arrest. Design/Methods: Twenty-seven term fetal lambs in cardiac arrest induced by cord occlusion were instrumented and resuscitated following randomization to epinephrine or vasopressin through a low umbilical venous catheter. Results: Eight lambs achieved ROSC prior to medication. Epinephrine achieved ROSC in 7/10 lambs by 8 ± 2 min. Vasopressin achieved ROSC in 3/9 lambs by 13 ± 6 min. Plasma vasopressin levels in nonresponders were much lower than responders after the first dose. Vasopressin caused in vivo increased pulmonary blood flow and in vitro coronary vasoconstriction. Conclusions: Vasopressin resulted in lower incidence and longer time to ROSC compared to epinephrine in a perinatal model of cardiac arrest supporting the current recommendations for exclusive use of epinephrine in neonatal resuscitation

Anesthesia · Cardiology · Epinephrine · Randomized controlled trial · Vasopressin · Cardiac Arrest and Resuscitation · Mechanical Circulatory Support Devices · Medicine · Neuroscience of respiration and sleep · Internal Medicine

Tools

Open DOIOpen Access