Survival with full neurologic recovery and no cerebral pathology after prolonged cardiopulmonary resuscitation with vasopressin in pigs

Wenzel, Volker; Lindner, Karl H.; Krismer, Anette C.; Voelckel, Wolfgang G.; Schocke, Michael; Hund, Wolfgang; Witkiewicz, Markus; Miller, Egfried A.; Klima, G.; Wissel, Jörg; Lingnau, Werner; Aichner, F.

doi:10.1016/s0735-1097(99)00562-8

Cited by 140 publications

(42 citation statements)

References 33 publications

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“…Despite the sensitivity of the search strategy used and the large number of published papers on this subject (485 studies), only six trials satisfied the strict inclusion criteria. In contrast to findings regarding patients with ventricular fibrillation, pulseless electrical activity or asystole, (4,10,23,(33)(34) the results of clinical trials did not support the addition of vasopressin to epinephrine in cardiac arrest resuscitation, except in a subgroup looking at survival rate at 24h. For in-hospital patients, the vasopressin and epinephrine group failed to show any improvement compared with epinephrine for either 1 h survival or survival to hospital discharge.…”

Section: Discussioncontrasting

confidence: 72%

Vasopressin and epinephrine versus epinephrine in management of patients with cardiac arrest: a meta-analysis

Jing

Wang

et al. 2010

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Section: Discussioncontrasting

confidence: 72%

Vasopressin and epinephrine versus epinephrine in management of patients with cardiac arrest: a meta-analysis

Jing

Wang

et al. 2010

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“…In this regard it is noteworthy that six of seven animals had return of spontaneous circulation without pharmacologic intervention. When compared with an adult animal study consisting of 4 min of cardiac arrest and 18 min of CPR, neither standard CPR alone nor treatment with epinephrine rendered defibrillation successful (20). Accordingly, results from our present and a previous study (17) may provide further evidence that ACD ϩ ITV CPR may be considered as an effective tool to gain time during prolonged CPR efforts.…”

Section: Discussionmentioning

confidence: 51%

Effects of Active Compression-Decompression Cardiopulmonary Resuscitation with the Inspiratory Threshold Valve in a Young Porcine Model of Cardiac Arrest

et al. 2002

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Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) with the inspiratory threshold valve (ITV) has been recently recommended by the American Heart Association for treatment of adults in cardiac arrest (class IIb: alternative, useful intervention), but this new technique has never been used in a pediatric population. Thus, this study was designed to evaluate ACD ϩ ITV CPR in a young porcine model of cardiac arrest. After 10 min of ventricular fibrillation, and 8 min of standard CPR, ACD ϩ ITV CPR was performed in seven 4-to 6-wk-old pigs (8 -12 kg); defibrillation was attempted 8 min later. Within 2 min after initiation of ACD ϩ ITV CPR, mean (Ϯ SEM) coronary perfusion pressure increased from 18 Ϯ 2 to 24 Ϯ 3 mm Hg (p ϭ 0.018). During standard versus ACD ϩ ITV CPR, mean left ventricular myocardial and total cerebral blood flow was 59 Ϯ 21 versus 126 Ϯ 32 mL·min Ϫ1 ·100 g Ϫ1 , and 36 Ϯ 7 versus 60 Ϯ 15 mL· min Ϫ1 ·100 g Ϫ1 , respectively (p ϭ 0.028). Six of seven animals were successfully defibrillated, and survived Ͼ15 min. In conclusion, the combination of ACD ϩ ITV CPR significantly increased both coronary perfusion pressure and vital organ blood flow after prolonged standard CPR in this young porcine model of ventricular fibrillation. Pediatric cardiopulmonary arrest has a very poor prognosis, and survival rates range only from 2 to 17% (1, 2). Moreover, survivors often remain neurologically disabled (1). Inasmuch as current basic and ACLS methods often fail to restore cardiac function and preserve brain function, new alternative circulation methods merit evaluation in children. In this regard, the American Heart Association and European Resuscitation Council Guidelines emphasize the need for better data regarding epidemiology and treatment of pediatric cardiopulmonary arrest (3, 4).Intermittent impedance to the inflow of respiratory gases during the decompression phase of CPR has recently been shown to enhance CPR efficacy (5). As such, using an ITV improved coronary perfusion pressure and myocardial blood flow in both standard (6) and ACD CPR in adult animal models (7). Furthermore, coronary perfusion pressure was significantly higher in patients receiving ACD CPR with the ITV when compared with ACD CPR alone (8). However, neither ACD CPR alone nor ACD ϩ ITV CPR has been studied in a pediatric population yet, and a suitable ACD device for infants is not currently available. Moreover, in infants undergoing CPR, acquisition of rapid vascular access is not a simple task, even for an experienced emergency physician, and i.v. administration of vasopressor drugs may therefore be delayed, or even impossible. Whereas standard chest compressions alone are often ineffective to ensure adequate vital organ blood flow, ABSTRACT523

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“…In adult porcine CPR preparations with ventricular fibrillation 3 or postcountershock pulseless electrical activity, 4 vasopressin improved vital organ blood flow during CPR, 5 cerebral oxygen delivery, 6 resuscitability, 7 and neurological recovery 8 better than did epinephrine. Surprisingly, these beneficial effects of vasopressin could not be extrapolated to a model of pediatric asphyxial cardiac arrest, in which epinephrine was clearly superior to vasopressin with respect to improving vital-organ blood flow.…”

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confidence: 92%

Developing a Vasopressor Combination in a Pig Model of Adult Asphyxial Cardiac Arrest

et al. 2001

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Background-The purpose of this study was to investigate the effects of vasopressin versus epinephrine, and both drugs combined, in a porcine model of simulated adult asphyxial cardiac arrest. Methods and Results-At Ϸ7 minutes after the endotracheal tube had been clamped, cardiac arrest was present in 24 pigs and remained untreated for another 8 minutes. After 4 minutes of basic life support cardiopulmonary resuscitation, pigs were randomly assigned to receive, every 5 minutes, either epinephrine (

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Survival with full neurologic recovery and no cerebral pathology after prolonged cardiopulmonary resuscitation with vasopressin in pigs

Abstract: During prolonged CPR, repeated vasopressin administration, but not epinephrine or saline placebo, ensured long-term survival with full neurologic recovery and no cerebral pathology in this porcine CPR model.

Cited by 140 publications

References 33 publications

Vasopressin and epinephrine versus epinephrine in management of patients with cardiac arrest: a meta-analysis

Vasopressin and epinephrine versus epinephrine in management of patients with cardiac arrest: a meta-analysis

Effects of Active Compression-Decompression Cardiopulmonary Resuscitation with the Inspiratory Threshold Valve in a Young Porcine Model of Cardiac Arrest

Developing a Vasopressor Combination in a Pig Model of Adult Asphyxial Cardiac Arrest

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