Cardiopulmonary resuscitation of a near-drowned child with a combination of epinephrine and vasopressin

Lienhart, H.; John, Wolfgang; Wenzel, Volker

doi:10.1097/01.pcc.0000163673.40424.e7

Cited by 14 publications

(8 citation statements)

References 21 publications

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“…Human trials of medication use in accidental hypothermia do not exist, although case reports of survival with use of intra-arrest medication have been reported. 414,418,437 Given the lack of human evidence and relatively small number of animal investigations, the recommendation for administration or withholding of medications is not clear. It may be reasonable to consider administration of a vasopressor during cardiac arrest according to the standard ACLS algorithm concurrent with rewarming strategies (Class IIb, LOE C).…”

Section: Acls Modificationsmentioning

confidence: 99%

Part 12: Cardiac Arrest in Special Situations

Hoek¹,

Morrison²,

Shüster³

et al. 2010

Circulation

660

437

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Section: Acls Modificationsmentioning

confidence: 99%

Part 12: Cardiac Arrest in Special Situations

Hoek¹,

Morrison²,

Shüster³

et al. 2010

Circulation

660

437

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“…In the subgroup of patients with initial rhythm asystole, it improves the hospital discharge rate. Lienhart et al [19] and Sumann et al [20] reported that vasopressors could be useful to restore spontaneous circulation in hypothermic cardiac arrest patients prior to rewarming, thus avoiding prolonged mechanical CPR efforts or use of extracorporeal circulation. Compared with epinephrine, vasopressin exerts greater vasoconstriction in hypoxic and acidotic conditions [21].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest

2009

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BackgroundIn 2003, the International Liaison Committee on Resuscitation (ILCOR) published the Recommended Guidelines for Uniform Reporting of Data from Drowning: the “Utstein style” (“Utstein Style for Drowning,” USFD) to improve the understanding of epidemiology, treatment, and outcome prediction after drowning.AimsThe aim of this study was to compare the characteristics and outcome between patients suffering from out-of-hospital primary cardiac arrest (OHPCA) and drowning victims in cardiac arrest (DCA) by analysis of variables based on the USFD.MethodsAll cases of OHPCA and DCA from February 1998 to February 2007 were included in the research and analysis. Data on OHPCA and DCA patients were collected using the Utstein method. Data on DCA patients were then compared with data of OHPCA patients.ResultsDuring the study period 788 cardiac arrests with resuscitation attempts were identified: 528 of them were OHPCA (67%) and 32 (4%) were DCA. The differences between DCA and OHPCA patients were: the DCA patients were younger (46.5 ± 21.4 vs 62.5 ± 15.8; p = 0.01), suffered a witnessed cardiac arrest less frequently (9/32 vs 343/528; p = 0.03), were more often found in a nonshockable rhythm (29/32 vs 297/528; p < 0.0001), had a prolonged ambulance response time (11 vs 6 min; p = 0.001), had a relatively better (but not statistically significant) return of spontaneous circulation (ROSC) in the field [22/32 (65%) vs 301/528 (57%); p = 0.33], more of them were admitted to hospital [19/32 (60%) vs 253/528 (48%); p = 0.27], and also had a significantly higher survival rate (discharge from hospital) [14/32 (44%) vs 116/528 (22%); p = 0.01]. DCA patients had higher values of initial PETCO2 (53.2 ± 16.8 vs 15.8 ± 8.3 mmHg; p < 0.0001) and average PETCO2 (43.5 ± 13.8 vs 23.5 ± 8.2; p = 0.002). These values of PETCO2 suggest an asphyxial mechanism of cardiac arrest. The analysis showed that DCA patients who survived were younger, had more bystander cardiopulmonary resuscitation (CPR), shorter call-arrival interval, higher values of PETCO2 after 1 min of CPR, higher average and final values of PETCO2, lower value of initial serum K+, and more of them received vasopressin (p < 0.05) in comparison with DCA patients who did not survive.ConclusionDCA patients had a better survival rate (discharge from hospital), higher initial and average PETCO2 values, and more of them had nonshockable initial rhythm. Survival (discharge from hospital) in DCA patients is associated with the PETCO2 values, initial serum K+ values, administration of vasopressin, and ambulance response time.

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“…[10][11][12] On the other hand, the benefit of administering medications to treat VT/VF in severely hypothermic patients has not been established. Although there have been some case reports of improved survival with the use of medications in accidental hypothermia patients, 13,14 there have been no human interventional studies. In a systematic review of animal studies, vasopressor-like epinephrine or vasopressin improved the return of spontaneous circulation, but antiarrhythmic drugs such as amiodarone or bretylium did not result in an increased rate of return of spontaneous circulation.…”

Section: Discussionmentioning

confidence: 98%

Accidental hypothermia-induced electrical storm successfully treated with isoproterenol

et al. 2015

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Cardiopulmonary resuscitation of a near-drowned child with a combination of epinephrine and vasopressin

Abstract: Bystander cardiopulmonary resuscitation, early and aggressive advanced life support, rewarming, and the combination of intravenous epinephrine and vasopressin were associated with sustained return of spontaneous circulation following hypothermic submersion-associated cardiac arrest.

Cited by 14 publications

References 21 publications

Part 12: Cardiac Arrest in Special Situations

Part 12: Cardiac Arrest in Special Situations

Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest

Accidental hypothermia-induced electrical storm successfully treated with isoproterenol

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