Vasopressin versus epinephrine during neonatal cardiopulmonary resuscitation of asphyxiated post-transitional piglets

O’Reilly, Megan; Lee, Tze-Fun; Cheung, Po-Yin; Schmölzer, Georg M.

doi:10.1016/j.resplu.2023.100427

Cited by 2 publications

(2 citation statements)

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“…The epinephrine-resuscitated groups had increased post-resuscitation troponin compared to the vasopressin group [8]. A post-translational piglet model of asphyxia-induced asystolic cardiac arrest randomized 16 piglets to IV vasopressin (0.4 IU/kg) or epinephrine (0.02 mg/kg) [10]. Vasopressin significantly improved post-ROSC survival times compared to the epinephrine group (240 [240–240] versus 65 [30–240] min, respectively, p = 0.02), as well as arterial pressure, cerebral blood oxygen saturation, and heart rate 4 h after ROSC [10].…”

Section: Vasopressinmentioning

confidence: 99%

“…Vasopressin, an antidiuretic hormone, has vasoconstrictive action through V 1 -receptor stimulation resulting in pulmonary vasodilation and systemic vasoconstriction. Three neonatal animal studies using transitional and posttransitional models report conflicting results [8][9][10]. In pediatric and adult studies [11,12], vasopressin improved survival when asystole was the cardiac arrest rhythm.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Agents during Neonatal Cardiopulmonary Resuscitation

Ramsie,

Cheung,

O’Reilly

et al. 2024

Neonatology

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Background: Epinephrine (adrenaline) is currently the only cardiac agent recommended during neonatal resuscitation. The inability to predict which newborns are at risk of requiring resuscitative efforts at birth has prevented the collection of large, high-quality human data. Summary: Information on the optimal dosage and route of epinephrine administration is extrapolated from neonatal animal studies and human adult and pediatric studies. Adult resuscitation guidelines have previously recommended vasopressin use; however, neonatal studies needed to create guidelines are lacking. A review of the literature demonstrates conflicting results regarding epinephrine efficacy through various routes of access as well as vasopressin during asystolic cardiac arrest in animal models. Vasopressin appears to improve hemodynamic and post-resuscitation outcomes compared to epinephrine in asystolic cardiac arrest animal models. Key Messages: The current neonatal resuscitation guidelines recommend epinephrine be primarily given via the intravenous or intraosseous route, with the endotracheal route as an alternative if these routes are not feasible or unsuccessful. The intravenous or intraosseous dose ranges between 0.01 and 0.03 mg/kg, which should be repeated every 3–5 min during chest compressions. However, the optimal dosing and route of administration of epinephrine remain unknown. There is evidence from adult and pediatric studies that vasopressin might be an alternative to epinephrine; however, the neonatal data are scarce.

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Section: Vasopressinmentioning

confidence: 99%