A comparison of the combination of epinephrine and vasopressin with lipid emulsion in a porcine model of asphyxial cardiac arrest after intravenous injection of bupivacaine.
BACKGROUND
In a porcine model, we compared the effect of the combination of vasopressin/epinephrine with that of a lipid emulsion on survival after bupivacaine-induced cardiac arrest.


METHODS
After administration of 5 mg/kg of a 0.5% bupivacaine solution i.v., ventilation was interrupted for 2 +/- 0.5 (mean +/- SD) min until asystole occurred. Cardiopulmonary resuscitation (CPR) was initiated after 1 min of untreated cardiac arrest. After 2 min of CPR, 10 animals received, every 5 min, either vasopressin combined with epinephrine or 4 mL/kg of a 20% lipid emulsion. Three minutes after each drug administration, up to three countershocks (4, 4, and 6 J/kg) were administered; all subsequent shocks with 6 J/kg. Blood for determination of the plasma bupivacaine concentration was drawn throughout the experiment.


RESULTS
In the vasopressor group, all five pigs survived, whereas none of five pigs in the lipid group had restoration of spontaneous circulation (P < 0.01). There was no significant difference between groups in the plasma concentration of total bupivacaine.


CONCLUSIONS
In this model of a bupivacaine-induced cardiac arrest, the vasopressor combination of vasopressin and epinephrine compared with lipid emulsion resulted in higher coronary perfusion pressure during CPR and survival rates.
Mayr
Viktoria D
VD
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. viktoria.mayr@i-med.ac.at
Mitterschiffthaler
Lukas
L
Neurauter
Andreas
A
Gritsch
Christian
C
Wenzel
Volker
V
Müller
Tilko
T
Luckner
Günter
G
Lindner
Karl H
KH
Strohmenger
Hans-Ulrich
HU
D000779:Anesthetics, Local / Q000008:administration & dosage / Q000097:blood; D000818:Animals; D001237:Asphyxia / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D002045:Bupivacaine / Q000008:administration & dosage / Q000097:blood; D016887:Cardiopulmonary Resuscitation; D003326:Coronary Circulation / Q000187:drug effects; D004195:Disease Models, Animal; D004554:Electric Countershock; D004837:Epinephrine / Q000494:pharmacology* / Q000627:therapeutic use; D005217:Fat Emulsions, Intravenous / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000187:drug effects; D007275:Injections, Intravenous; D008297:Male; D013552:Swine; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000494:pharmacology* / Q000627:therapeutic use; D014667:Vasopressins / Q000494:pharmacology* / Q000627:therapeutic use
D000779:Anesthetics, Local; D005217:Fat Emulsions, Intravenous; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D002045:Bupivacaine; D004837:Epinephrine