Pediatric cardiac arrest refractory to advanced life support: is there a role for terlipressin?
OBJECTIVE
Pediatric cardiac arrest unresponsive to advanced life support and several adrenaline doses has a very poor prognosis. Alternative vasopressors could improve the results of resuscitation in such cases. We report our experience with the compassionate administration of terlipressin in children who suffered in-pediatric intensive care unit cardiac arrest and did not respond to immediate advanced life support and at least three epinephrine doses.


METHODS
Prospective multicenter registry.


METHODS
Three pediatric intensive care units at university-affiliated tertiary care children's hospitals.


METHODS
Five pediatric patients, aged 5 mos to 12 yrs, with in-pediatric intensive care unit cardiac arrest unresponsive to advanced life support that included at least three epinephrine doses.


METHODS
Addition of terlipressin (10-20 microg/kg intravenous, up to two doses) to standard cardiopulmonary resuscitation.


RESULTS
Sustained return of spontaneous circulation was achieved in four cases, two of them were declared dead 6 and 12 hrs later, and the remaining two survived without cardiopulmonary procedures-related sequelae and with good neurologic condition.


CONCLUSIONS
Terlipressin might contribute to obtain sustained return of spontaneous circulation in children with refractory in-hospital cardiac arrest. A randomized controlled clinical trial should be conducted to investigate the optimal drug treatment in pediatric cardiac arrest.
Gil-Antón
Javier
J
Pediatric Intensive Care Unit, Hospital de Cruces, Barakaldo, Bizkaia, Spain.
López-Herce
Jesús
J
Morteruel
Elvira
E
Carrillo
Angel
A
Rodríguez-Núñez
Antonio
A
D022561:Advanced Cardiac Life Support; D002648:Child; D002675:Child, Preschool; D057176:Compassionate Use Trials; D004305:Dose-Response Relationship, Drug; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D011446:Prospective Studies; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin