Vasopressin improves vital organ blood flow after prolonged cardiac arrest with postcountershock pulseless electrical activity in pigs.
OBJECTIVE
Although a benefit of vasopressin when compared with epinephrine was shown during cardiopulmonary resuscitation (CPR) after a short duration of ventricular fibrillation cardiac arrest, the effect of vasopressin during prolonged cardiac arrest with pulseless electrical activity is currently unknown.


METHODS
Prospective, randomized laboratory investigation using an established porcine model with instrumentation for measurement of hemodynamic variables, vital organ blood flow, blood gases, and return of spontaneous circulation.


METHODS
University hospital laboratory.


METHODS
Eighteen domestic pigs.


METHODS
After 15 mins of cardiac arrest and 3 mins of chest compressions, 18 animals were randomly treated with either 0.8 units/kg vasopressin (n = 9) or 200 microg/kg epinephrine (n = 9).


RESULTS
Compared with epinephrine, vasopressin resulted, at both 90 secs and 5 mins after drug administration, in significantly higher (p < .05) median (25th-75th percentiles) left ventricular myocardial blood flow (120 [range, 96-193] vs. 54 [range, 11-92] and 56 [range, 41-80] vs. 21 [range, 11-40] mL/min/100 g, respectively) and total cerebral blood flow (85 [78-102] vs. 24 [18-41] and 50 [44-52] vs. 8 [5-23] mL/min/100 g, respectively). Spontaneous circulation was restored in eight of nine animals in the vasopressin group and in one of nine animals in the epinephrine group (p = .003).


CONCLUSIONS
Compared with a maximum dose of epinephrine, vasopressin significantly increased left ventricular myocardial and total cerebral blood flow during CPR and return of spontaneous circulation in a porcine model of prolonged cardiac arrest with postcountershock pulseless electrical activity.
Wenzel
V
V
Department of Anesthesiology, University of Ulm, Germany.
Lindner
K H
KH
Prengel
A W
AW
Maier
C
C
Voelckel
W
W
Lurie
K G
KG
Strohmenger
H U
HU
D000818:Animals; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D003326:Coronary Circulation / Q000187:drug effects*; D004554:Electric Countershock; D004837:Epinephrine / Q000494:pharmacology / Q000627:therapeutic use*; D006323:Heart Arrest / Q000188:drug therapy* / Q000628:therapy; D006439:Hemodynamics / Q000187:drug effects; D011446:Prospective Studies; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods; D013552:Swine; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000494:pharmacology / Q000627:therapeutic use*; D014667:Vasopressins / Q000494:pharmacology / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D014667:Vasopressins; D004837:Epinephrine