Effects of vasopressin on adrenal gland regional perfusion during experimental cardiopulmonary resuscitation.
OBJECTIVE
Despite the important role of the adrenal gland during cardiac arrest, little is known about changes in the adrenal medullary or cortical blood flow in this setting. This study was designed to assess regional adrenal gland perfusion in the medulla and cortex during cardiopulmonary resuscitation (CPR), and after administration of adrenaline (epinephrine) versus vasopressin versus saline placebo.


METHODS
After 4 min of untreated ventricular fibrillation, and 3 min of basic life support CPR, 19 animals were randomly assigned to receive either vasopressin (0.4 U/kg; n=7), adrenaline (45 microg/kg; n=6) or saline placebo (n=6), respectively. Haemodynamic variables, adrenal, and renal blood flow were measured after 90 s of CPR, and 90 s and 5 min after drug administration.


RESULTS
All values are given as mean+/-S.E.M. Blood flow in the adrenal medulla was significantly higher 90 s after adrenaline when compared with saline placebo in the right adrenal medulla (210+/-14 vs. 102+/-5 ml/min per 100 mg), and in the left adrenal medulla (218+/-14 vs. 96+/-3 ml/min per 100 mg). Blood flow in the adrenal medulla was significantly higher 90 s and 5 min after vasopressin when compared with adrenaline in the right (326+/-22 mg vs. 210+/-14 ml/min per 100 mg, and 297+/-17 vs. 103+/-5 ml/min per 100 mg), and in the left medulla (333+/-25 vs. 218+/-14 ml/min per 100 mg, and 295+/-14 vs. 111+/-7 ml/min per 100 mg). Ninety seconds and five minutes after vasopressin, and 90 s after adrenaline, adrenal cortex blood flow was significantly higher when compared with saline placebo. After 12 min of cardiac arrest, including 8 min of CPR, seven of seven pigs in the vasopressin group, one of six pigs in the adrenaline group, but none of six placebo were successfully defibrillated.


CONCLUSIONS
Both vasopressin and adrenaline produced significantly higher medullary and cortical adrenal gland perfusion during CPR than did a saline placebo; but vasopressin resulted in significantly higher medullary adrenal gland blood flow when compared with adrenaline.
Krismer
Anette C
AC
Department of Anesthesiology and Critical Care Medicine, The Leopold-Franzens-University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. anette.krismer@uibk.ac.at
Wenzel
Volker
V
Voelckel
Wolfgang G
WG
Stadlbauer
Karl Heinz
KH
Wagner-Berger
Horst
H
Schaefer
Andreas
A
Lindner
Karl H
KH
D000311:Adrenal Glands / Q000098:blood supply* / Q000187:drug effects*; D000704:Analysis of Variance; D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004195:Disease Models, Animal; D004837:Epinephrine / Q000494:pharmacology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D008297:Male; D011336:Probability; D011897:Random Allocation; D012016:Reference Values; D012039:Regional Blood Flow; D012680:Sensitivity and Specificity; D013552:Swine; D014667:Vasopressins / Q000494:pharmacology*; D014693:Ventricular Fibrillation / Q000628:therapy*
D014667:Vasopressins; D004837:Epinephrine