Vasopressin versus continuous adrenaline during experimental cardiopulmonary resuscitation.
OBJECTIVE
To evaluate the effects of a bolus dose of vasopressin compared to continuous adrenaline (epinephrine) infusion on vital organ blood flow during cardiopulmonary resuscitation (CPR).


METHODS
Ventricular fibrillation was induced in 24 anaesthetised pigs. After a 5-min non-intervention interval, CPR was started. After 2 min of CPR the animals were randomly assigned to receive either vasopressin (0.4 U/kg) or adrenaline (bolus of 20 microg/kg followed by continuous infusion of 10 microg/(kg min)). Defibrillation was attempted after 9 min of CPR.


RESULTS
Vasopressin generated higher cortical cerebral blood flow (P < 0.001) and lower cerebral oxygen extraction (P < 0.001) during CPR compared to continuous adrenaline. Coronary perfusion pressure during CPR was higher in vasopressin-treated pigs (P < 0.001) and successful resuscitation was achieved in 12/12 in the vasopressin group versus 5/12 in the adrenaline group (P = 0.005).


CONCLUSIONS
In this experimental model, vasopressin caused a greater increase in cortical cerebral blood flow and lower cerebral oxygen extraction during CPR compared to continuous adrenaline. Furthermore, vasopressin generated higher coronary perfusion pressure and increased the likelihood of restoring spontaneous circulation.
Johansson
Jakob
J
Department of Surgical Sciences, Anaesthesiology & Intensive Care, Uppsala University Hospital, S-751 85 Uppsala, Sweden. jakob.johansson@surgsci.uu.se
Gedeborg
Rolf
R
Rubertsson
Sten
S
D000818:Animals; D001921:Brain / Q000378:metabolism; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002560:Cerebrovascular Circulation / Q000187:drug effects; D004562:Electrocardiography; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D010101:Oxygen Consumption / Q000187:drug effects; D013552:Swine; D014667:Vasopressins / Q000008:administration & dosage / Q000627:therapeutic use*; D014693:Ventricular Fibrillation / Q000209:etiology
D014667:Vasopressins; D004837:Epinephrine