Survival with Full Neurologic Recovery After Prolonged Cardiopulmonary Resuscitation with a Combination of Vasopressin and Epinephrine in Pigs

Stadlbauer, Karl H.; Wagner-Berger, Horst G.; Wenzel, Volker; Voelckel, Wolfgang G.; Krismer, Anette C.; Klima, Gu Combining Diaeresis Nter; Rheinberger, Klaus; Pechlaner, Sebastian; Mayr, Viktoria D.; Lindner, Karl H.

doi:10.1213/01.ane.0000066017.66951.7f

Cited by 54 publications

(22 citation statements)

References 14 publications

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“…As this study was not designed to evaluate longterm survival and neurologic function, we are unable to assess whether a high cerebral blood flow in the AVP and the AVP/EPI/NE group might have beneficial effects on neurologic outcome after restoration of spontaneous circulation. However, in a previous porcine model of CPR, repeated administration of EPI together with AVP ensured long-term survival with full neurologic recovery (32).…”

Section: Discussionmentioning

confidence: 92%

Effects of combined administration of vasopressin, epinephrine, and norepinephrine during cardiopulmonary resuscitation in pigs*

Prengel

Linstedt

Zenz

et al. 2005

Critical Care Medicine

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Section: Discussionmentioning

confidence: 92%

Effects of combined administration of vasopressin, epinephrine, and norepinephrine during cardiopulmonary resuscitation in pigs*

Prengel

Linstedt

Zenz

et al. 2005

Critical Care Medicine

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“…They found that coronary perfusion pressure, left ventricular myocardial blood flow, and ROSC rates were higher in the 45 and 90 mcg/kg groups compared to the two lower dose groups. Further studies established that the combination of epinephrine and vasopressin was superior in the swine model of ventricular fibrillation, 41, 42 pulseless electrical activity, 43 asphyxial cardiac arrest 44–46 and recently in the swine model of bupivacaine-induced cardiac arrest. 9 …”

Section: Discussionmentioning

confidence: 99%

Lipid Emulsion Combined with Epinephrine and Vasopressin Does Not Improve Survival in a Swine Model of Bupivacaine-induced Cardiac Arrest

Hicks

Salcido²,

Logue³

et al. 2009

Anesthesiology

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Background We sought to evaluate the efficacy of lipid emulsion in reversing bupivacaine-induced cardiovascular collapse when added to a resuscitation protocol that included the use of epinephrine and vasopressin. Methods Following induction of general anesthesia and instrumentation, 19 mixed-breed domestic swine had cardiovascular collapse induced by an intravenous bolus of 10 mg/kg bupivacaine. After 5 minutes of resuscitation including chest compressions, epinephrine (100 μg/kg) and vasopressin (1.5 u/kg), animals were randomized to receive either a bolus of 20% lipid emulsion (4 mL/kg) followed by a continuous infusion (0.5 mL· kg−1 ·min−1) or an equal volume of saline. Investigators were blinded to the treatment assignment. The primary end-point was return of spontaneous circulation (mean arterial pressure of ≥ 60 mmHg for ≥ 1 minute). Results Treatment groups were similar with respect to baseline measurements of weight, sex, hemodynamic and metabolic variables. The rates of return of spontaneous circulation were similar between groups, 3 of 10, in the lipid group, and 4 of 9, in the saline group (P = 0.65). Total serum bupivacaine concentrations were higher in the lipid group at the 10-minute time point, (mean ± SEM: 23.13 ± 5.37 ng/mL versus 15.33 ± 4.04 ng/mL, P = 0.004). More norepinephrine was required in the lipid group compared to the saline group to maintain a mean arterial pressure > 60 mmHg during the 60 minute survival period (mean ± SEM: 738.6 ± 94.4 vs. 487.3 ± 171.0 μg). Conclusions In this swine model, lipid emulsion did not improve rates of return of spontaneous circulation after bupivacaine-induced cardiovascular collapse.

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“…Mayr et al[26] confirmed that the combined application of vasopressin and epinephrine rapidly elevated coronary perfusion pressure and the return of spontaneous circulation in pigs during cardiopulmonary resuscitation. Stadlbauer et al[27] observed that the combined application of vasopressin and epinephrine obviously increased coronary perfusion pressure, and returned spontaneous circulationin patients. Another study suggested that cerebral blood flow was reduced in patients treated with both vasopressin and epinephrine compared with those treated with vasopressin or epinephrinealone[28].…”

Section: Discussionmentioning

confidence: 99%

Vasopressin decreases neuronal apoptosis during cardiopulmonary resuscitation

Zhu

Wang

et al. 2014

Neural Regen Res

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The American Heart Association and the European Resuscitation Council recently recommended that vasopressin can be used for cardiopulmonary resuscitation, instead of epinephrine. However, the guidelines do not discuss the effects of vasopressin during cerebral resuscitation. In this study, we intraperitoneally injected epinephrine and/or vasopressin during cardiopulmonary resuscitation in a rat model of asphyxial cardiac arrest. The results demonstrated that, compared with epinephrine alone, the pathological damage to nerve cells was lessened, and the levels of c-Jun N-terminal kinase and p38 expression were significantly decreased in the hippocampus after treatment with vasopressin alone or the vasopressin and epinephrine combination. No significant difference in resuscitation effects was detected between vasopressin alone and the vasopressin and epinephrine combination. These results suggest that vasopressin alone or the vasopressin and epinephrine combination suppress the activation of mitogen-activated protein kinase and c-Jun N-terminal kinase signaling pathways and reduce neuronal apoptosis during cardiopulmonary resuscitation.

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Survival with Full Neurologic Recovery After Prolonged Cardiopulmonary Resuscitation with a Combination of Vasopressin and Epinephrine in Pigs

Cited by 54 publications

References 14 publications

Effects of combined administration of vasopressin, epinephrine, and norepinephrine during cardiopulmonary resuscitation in pigs*

Effects of combined administration of vasopressin, epinephrine, and norepinephrine during cardiopulmonary resuscitation in pigs*

Lipid Emulsion Combined with Epinephrine and Vasopressin Does Not Improve Survival in a Swine Model of Bupivacaine-induced Cardiac Arrest

Vasopressin decreases neuronal apoptosis during cardiopulmonary resuscitation

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