title: Effects of epinephrine and vasopressin in a piglet model of prolonged ventricular fibrillation and cardiopulmonary resuscitation.
abstract: OBJECTIVE
  We recently demonstrated that vasopressin alone resulted in a poorer outcome in a pediatric porcine model of asphyxial cardiac arrest when compared with epinephrine alone or with epinephrine plus vasopressin in combination. Accordingly, this study was designed to differentiate whether the inferior effects of vasopressin in pediatrics were caused by the type of cardiac arrest.
  
  
  METHODS
  Prospective, randomized laboratory investigation that used an established porcine model for measurement of hemodynamic variables and organ blood flow.
  
  
  METHODS
  University hospital laboratory.
  
  
  METHODS
  Eighteen piglets weighing 8-11 kg.
  
  
  METHODS
  After 8 mins of ventricular fibrillation and 8 mins of cardiopulmonary resuscitation, either 0.4 units/kg vasopressin (n = 6), 45 microg/kg epinephrine (n = 6), or a combination of 45 microg/kg epinephrine with 0.8 units/kg vasopressin (n = 6) was administered. Six minutes after drug administration, a second respective bolus dose of 0.8 units/kg vasopressin, 200 microg/kg epinephrine, or a combination of 200 microg/kg epinephrine with 0.8 units/kg vasopressin was given. Defibrillation was attempted 20 mins after initiating cardiopulmonary resuscitation.
  
  
  RESULTS
  Mean +/- sem left ventricular myocardial blood flow 2 mins after each respective drug administration was 65 +/- 4 and 70 +/- 13 mL x min(-1) x 100 g(-1) in the vasopressin group; 83 +/- 42 and 85 +/- 41 mL x min(-1) x 100 g(-1) in the epinephrine group; and 176 +/- 32 and 187 +/- 29 mL x min(-1) x 100 g(-1) in the epinephrine-vasopressin group (p <.006 after both doses of epinephrine-vasopressin vs. vasopressin and after the first dose of epinephrine-vasopressin vs. epinephrine, respectively). At the same times, mean +/- sem total cerebral blood flow was 73 +/- 3 and 47 +/- 5 mL x min(-1) x 100 g(-1) after vasopressin; 18 +/- 2 and 12 +/- 2 mL x min(-1) x 100 g(-1) after epinephrine; and 79 +/- 21 and 41 +/- 8 mL x min(-1) x 100 g(-1) after epinephrine-vasopressin (p <.025 after both doses of vasopressin and epinephrine-vasopressin vs. epinephrine). Five of six vasopressin-treated, two of six epinephrine-treated, and six of six epinephrine-vasopressin treated animals had return of spontaneous circulation (nonsignificant).
  
  
  CONCLUSIONS
  In this pediatric porcine model of ventricular fibrillation, the combination of epinephrine with vasopressin during cardiopulmonary resuscitation resulted in significantly higher levels of left ventricular myocardial blood flow than either vasopressin alone or epinephrine alone. Both vasopressin alone and the combination of epinephrine with vasopressin, but not epinephrine alone, improved total cerebral blood flow during cardiopulmonary resuscitation. In stark contrast to asphyxial cardiac arrest, vasopressin alone or in combination with epinephrine appears to be of benefit after ventricular fibrillation in the pediatric porcine model.
authors: Cardiac Arrhythmia Cente, Cardiovascular Division, Department of Medicine at the University of Minnesota, Minneapolis, MN, USA.
authors: Wolfgang G
authors: WG
authors: Voelckel
authors: Keith G
authors: KG
authors: Lurie
authors: Scott
authors: S
authors: McKnite
authors: Todd
authors: T
authors: Zielinski
authors: Paul
authors: P
authors: Lindstrom
authors: Colleen
authors: C
authors: Peterson
authors: Volker
authors: V
authors: Wenzel
authors: Karl H
authors: KH
authors: Lindner
authors: David
authors: D
authors: Benditt
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003326:Coronary Circulation / Q000187:drug effects; D004195:Disease Models, Animal; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects; D011446:Prospective Studies; D011897:Random Allocation; D013552:Swine; D014667:Vasopressins / Q000008:administration & dosage / Q000494:pharmacology*; D014693:Ventricular Fibrillation / Q000503:physiopathology*
chemical_list: D014667:Vasopressins; D004837:Epinephrine