Vasopressin Improves Vital Organ Blood Flow During Closed-Chest Cardiopulmonary Resuscitation in Pigs

Lindner, Karl H.; Prengel, Andreas W.; Pfenninger, E; Lindner, Ingrid M.; Strohmenger, Hans-Ulrich; Georgieff, Michael; Lurie, Keith G.

doi:10.1161/01.cir.91.1.215

Cited by 284 publications

(96 citation statements)

References 23 publications

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“…As an alternative therapy, Morales et al (1999) reported a set of canine experiments where vasopressin levels showed a marked increase at the onset of blood loss followed by a fall to well below the normal physiological level. Voelckel et al (2000) and Lindner et al (1995) demonstrated that the administration of vasopressin improved the survival rate in porcine cases and more recently Krismer et al (2005) reported for human as well. Excessive doses of vasopressin however have been known to induce injuries to the gastrointestinal tract, skin, myocardium and liver (Malay et al 2004;Yoo et al 2007).…”

Section: Introductionmentioning

confidence: 80%

A robust, electrochemically driven microwell drug delivery system for controlled vasopressin release

Chung

Huh

Erickson

2009

Biomed Microdevices

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Micro-electro-mechanical-system (MEMS) based implantable drug delivery devices represent a promising approach to achieving more precise dosing, faster release and better localization of therapeutic compounds than is possible with existing technology. Despite recent advancements, there remain challenges in being able to build systems that enable active control over the dose rate and release time, in a robust, low power but simple to fabricate package. Here we demonstrate an implantable micro-reservoir device that enables delivery of dose volumes as high as 15 microl using an electrochemically based transport mechanism. This approach allows for a significant reduction in the amount of time required for drug delivery as well as reducing the dependence on the external physiological conditions. We present the overall design, operating principle and construction of the device, and experimental results showing the volume transport rate as a function of the strength of the applied electric field. The concentration profile vs. time, the power consumption, and ejection efficiency are also investigated. To demonstrate the medical utility of the device we also characterize the in-vitro release of vasopressin.

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Section: Introductionmentioning

confidence: 80%

A robust, electrochemically driven microwell drug delivery system for controlled vasopressin release

Chung

Huh

Erickson

2009

Biomed Microdevices

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“…During ventricular fibrillation, doseresponse investigations of three vasopressin doses (0.2, 0.4, and 0.8 units/kg) compared with the maximum effective dose of 200 g/kg epinephrine showed that 0.8 units/kg vasopressin was the most effective drug for increasing vital organ blood flow (2). Also, vasopressin significantly improved cerebral oxygen delivery and the ventricular fibrillation mean frequency during CPR when compared with a maximum dose of epinephrine (3).…”

Section: Arginine Vasopressin During Cpr In Laboratory Modelsmentioning

confidence: 97%

Arginine vasopressin during cardiopulmonary resuscitation: Laboratory evidence, clinical experience and recommendations, and a view to the future

Wenzel¹,

Lindner²

2002

Critical Care Medicine

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When stimulating adult pigs with ventricular fibrillation or postcountershock pulseless electrical activity for cardiopulmonary resuscitation, vasopressin improved vital organ blood flow, cerebral oxygen delivery, ability to be resuscitated, and neurologic recovery better than epinephrine. In pediatric preparations with asphyxia, epinephrine was superior to vasopressin, whereas in both pediatric pigs with ventricular fibrillation and adult porcine models with asphyxia, combinations of vasopressin and epinephrine proved to be highly effective. This may suggest that a different efficiency of vasopressors in pediatric vs. adult preparations and different effects of dysrhythmic vs. asphyxial cardiac arrest on vasopressor efficiency may be of significant importance. Whether these theories can be extrapolated to humans is unknown at this time. In patients who experienced out-of-hospital ventricular fibrillation, a larger proportion of patients treated with vasopressin survived 24 hrs compared with patients treated with epinephrine; during in-hospital cardiopulmonary resuscitation, comparable short-term survival was found in groups treated with either vasopressin or epinephrine. Currently, a large trial comprising patients who experience out-of-hospital cardiac arrest and who are treated with vasopressin vs. epinephrine is ongoing in Germany, Austria, and Switzerland. The new cardiopulmonary resuscitation guidelines of both the American Heart Association and the European Resuscitation Council consider 40 units of vasopressin intravenously and 1 mg of epinephrine intravenously equally effective for the treatment of adult patients with ventricular fibrillation; however, because of a lack of clinical data, no recommendation for vasopressin has been made for adult patients with asystole and pulseless electrical activity or for pediatric patients.

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“…Unter diesen Gesichtspunkten würde Adrenalin heute für die Therapie bei einer CPR nicht mehr zugelassen werden; vielmehr genießt es lediglich eine Art "Verbleiberecht" aufgrund der historischen Tradition, was die Amerikaner als "grandfather rule" bezeichnen. Daher wird zwar In tierexperimentellen CPR-Untersuchungen konnte mit Vasopressin, dem in der Hirnanhangsdrüse gebildeten antidiuretischem Hormon, ein signifikant höherer linksventrikulärer myokardialer und zerebraler Blutfluss nachgewiesen werden als mit der maximal wirksamen Adrenalindosis [70,152]. Weiterhin war bei Schweinen das zerebrale Sauerstoffangebot mit Vasopressin höher als bei einer Reanimation mit Adrenalin [97].…”

Section: Adrenalin Oder Vasopressin Als Vasopressorunclassified

Die neuen internationalen Richtlinien zur kardiopulmonalen Reanimation

et al. 2001

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In August 2000, the American Heart Association and the European Resuscitation Council published the conclusions of the International Guidelines 2000 Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care which contains both the new recommendations and an in-depth review. The discussions and drafting began at a conference in March 1999, followed by a second conference in September 1999, both attended by approx. 250 participants and another conference in February 2000 which was attended by approx. 500 participants. Review of the current state of science, discussion and final consensus continued subsequently via email, conference calls, fax, and personal conversation. During the entire process, scientists and resuscitation councils from all over the world participated, with participants from the United States comprising approx. 60%, and scientists from outside of the United States comprising approx. 40%. In order to ensure that the CPR recomendations are not dominated by any given nation or resuscitation council, most topics were reviewed and interpretated by two scientists from the United States and two scientists from outside of the United States. Accordingly, changes in these new CPR recommendations are the result of an evidence-based review by worldwide experts. The most important changes in the recommendations according to the authors are discontinuation of the pulse-check for lay people, 500 ml instead of 800-1200 ml tidal volume during bag-valve-mask ventilation (FiO2 > 0.4) of a patient with an unprotected airway, verifying correct endotracheal intubation with capnography and an esophageal detector, employing mechanical devices such as interposed abdominal compression CPR, vest CPR, active-compression-decompression CPR, and the inspiratory threshold valve (ITV) CPR as alternatives or adjuncts to standard manual chest compressions, defibrillation with < 200 Joule biphasic instead of with 200-360 Joule monophasic impulses, vasopressin (40 units) and epinephrine (1 mg) as comparable drugs to treat patients with ventricular fibrillation, amiodarone (300 mg) for shock-refractory ventricular fibrillation and intravenous lysis for patients who have suffered a stroke.

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Vasopressin Improves Vital Organ Blood Flow During Closed-Chest Cardiopulmonary Resuscitation in Pigs

Abstract: We conclude that administration of vasopressin leads to a significantly higher coronary perfusion pressure and myocardial blood flow than epinephrine during closed-chest CPR in a pig model of ventricular fibrillation.

Cited by 284 publications

References 23 publications

A robust, electrochemically driven microwell drug delivery system for controlled vasopressin release

A robust, electrochemically driven microwell drug delivery system for controlled vasopressin release

Arginine vasopressin during cardiopulmonary resuscitation: Laboratory evidence, clinical experience and recommendations, and a view to the future

Die neuen internationalen Richtlinien zur kardiopulmonalen Reanimation

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