title: Survival with full neurologic recovery after prolonged cardiopulmonary resuscitation with a combination of vasopressin and epinephrine in pigs.
abstract: We sought to determine the effects of a combination of vasopressin and epinephrine on neurologic recovery in comparison with epinephrine alone and saline placebo alone in an established porcine model of prolonged cardiopulmonary resuscitation (CPR). After 4 min of cardiac arrest, followed by 3 min of basic life support CPR, 17 animals were randomly assigned to receive, every 5 min, either a combination of vasopressin and epinephrine (vasopressin [IU/kg]/epinephrine [ micro g/kg]: 0.4/45, 0.4/45, and 0.8/45; n = 6), epinephrine alone (45, 45, and 200 micro g/kg; n = 6), or saline placebo alone (n = 5). After 22 min of cardiac arrest, including 18 min of CPR, defibrillation was attempted to achieve the return of spontaneous circulation. Aortic diastolic pressure was significantly (P < 0.01) increased 90 s after each of 3 vasopressin/epinephrine injections versus epinephrine alone versus saline placebo alone (mean +/- SEM: 69 +/- 3 mm Hg versus 45 +/- 3 mm Hg versus 29 +/- 2 mm Hg, 63 +/- 4 mm Hg versus 27 +/- 3 mm Hg versus 23 +/- 1 mm Hg, and 52 +/- 4 mm Hg versus 21 +/- 3 mm Hg versus 16 +/- 3 mm Hg, respectively). Spontaneous circulation was restored in six of six vasopressin/epinephrine pigs, whereas six of six epinephrine and five of five saline placebo pigs died (P < 0.01). Neurologic evaluation 24 h after successful resuscitation revealed only an unsteady gait and was normal 5 days after the experiment in all vasopressin/epinephrine-treated animals. In conclusion, in this porcine model of prolonged CPR, repeated vasopressin/epinephrine administration, but not epinephrine or saline placebo alone, ensured long-term survival with full neurologic recovery.
  
  
  CONCLUSIONS
  We present a study to evaluate the effects of a combination of vasopressin and epinephrine during prolonged cardiopulmonary resuscitation on neurological outcome in pigs. We found that all pigs treated with a combination of vasopressin and epinephrine could be resuscitated and had full neurologic recovery observed over an entire period of 5 days.
authors.affiliation: Departments of *Anesthesiology and Critical Care Medicine and †Histology, Leopold-Franzens-University, Innsbruck, Austria.
authors.forename: Karl H
authors.initials: KH
authors.lastname: Stadlbauer
authors.forename: Horst G
authors.initials: HG
authors.lastname: Wagner-Berger
authors.forename: Volker
authors.initials: V
authors.lastname: Wenzel
authors.forename: Wolfgang G
authors.initials: WG
authors.lastname: Voelckel
authors.forename: Anette C
authors.initials: AC
authors.lastname: Krismer
authors.forename: Gu Combining Diaeresis Nter
authors.initials: GCDN
authors.lastname: Klima
authors.forename: Klaus
authors.initials: K
authors.lastname: Rheinberger
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pechlaner
authors.forename: Viktoria D
authors.initials: VD
authors.lastname: Mayr
authors.forename: Karl H
authors.initials: KH
authors.lastname: Lindner
mesh_terms: D000818:Animals; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001835:Body Weight; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects; D004338:Drug Combinations; D004554:Electric Countershock; D004562:Electrocardiography / Q000187:drug effects; D004837:Epinephrine / Q000627:therapeutic use*; D006323:Heart Arrest / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology; D019344:Lactic Acid / Q000097:blood; D009422:Nervous System Diseases / Q000517:prevention & control*; D013534:Survival; D013552:Swine; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014667:Vasopressins / Q000009:adverse effects / Q000627:therapeutic use*; D014693:Ventricular Fibrillation / Q000628:therapy
chemical_list: D004338:Drug Combinations; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D019344:Lactic Acid; D004837:Epinephrine