Early adrenaline administration does not improve circulatory recovery during resuscitation from severe asphyxia in newborn piglets

Abstract

Early adrenaline administration does not improve circulatory recovery during resuscitation from severe asphyxia in newborn piglets.Linnér, Rikard; Werner, Olof; Perez de Sá, Valéria; Cunha Goncalves, Doris General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. (28) AbstractAim of the study: To investigate the effects of early intravenous adrenaline administration on circulatory recovery, cerebral reoxygenation, and plasma catecholamine concentrations, after severe asphyxia-induced bradycardia and hypotension.Methods: One-day-old piglets were left in apnoea until heart rate and mean arterial pressure were less than 50 min -1 and 25 mmHg, respectively. They randomly received adrenaline, 10 µg kg -1 (n=16) or placebo (n=15) and were resuscitated with air ventilation and, when needed, closed-chest cardiac massage (CCCM). Eight not asphyxiated animals served as time controls.Results: CCCM was required in 13 piglets given adrenaline and in 13 given placebo. (ns). In the time controls, the concentrations were 0.4 (0.2-0.6) nmol l -1 of adrenaline and 1.8 (1.3-2.4) nmol l -1 of noradrenaline. (28)Conclusion: The high endogenous catecholamine levels, especially those of noradrenaline, may explain why early administered adrenaline did not significantly improve resuscitation outcome.

A review of approaches to optimise chest compressions in the resuscitation of asphyxiated newborns

“…Also, whether adrenaline has a place in newborn CPR at all remains controversial49–51 as the scarce amount of evidence is conflicting. In post-transitional asphyxiated pigs, 14% of animals achieved ROSC without vasopressors,49 and administration of 10 µg/kg adrenaline prior to initiation of CC did not improve ROSC or cerebral circulation and oxygenation compared with placebo 51. In contrast, 10–15 µg/kg adrenaline was needed to achieve ROSC in a transitional lamb asphyxia-model 52.…”

One oxygen breath shortened the time to return of spontaneous circulation in severely asphyxiated piglets

“…Asphyxia was induced in three steps (13). Firstly, the piglet was ventilated with air for 15 minutes at a ventilator rate of just 5 min À1 with an unchanged tidal volume, namely hypoventilation.…”

“…The apnoea was allowed to last a maximum of eight minutes. These criteria were less strict than in two of our previous studies, so that all animals could be resuscitated if they were given optimum treatment (4,13). A participant outside the laboratory then randomly assigned the animals to resuscitation with oxygen (n = 8) or air (n = 8).…”

Evidence on Adrenaline Use in Resuscitation and Its Relevance to Newborn Infants: A Non-Systematic Review

“…Linner et al [19] studied early adrenaline administration in newborn piglets with severe asphyxia and bradycardia. Adrenaline was administered prior to CC, which did not improve ROSC or cerebral regional oxygen saturation when compared to placebo.…”

“…In asphyxiated newborn infants with fluid-filled lungs and open vascular shunts, there is limited evidence regarding both the effectiveness and safety of adrenaline [13]. Current controversies surrounding the use of adrenaline in neonatal CPR include (1) the effects of adrenaline versus placebo or no adrenaline [14], (2) optimal dose [15], (3) route of administration [16,17], (4) timing of administration [18,19], (5) alternative vasopressors [11], and (6) use in preterm infants [20]. The aim of this review is to summarise a selection of available evidence regarding the use of adrenaline during resuscitation and its relevance to asphyxiated newborn infants.…”