title: Combination pharmacotherapy improves neurological outcome after asphyxial cardiac arrest.
abstract: OBJECTIVE
  To study the effects of the combination of adrenaline (epinephrine) and vasopressin compared to adrenaline alone on initial resuscitation success, 24h survival, and neurological outcome in a swine model of asphyxial cardiac arrest (CA).
  
  
  METHODS
  This prospective randomized experimental study was conducted at a laboratory research department. Twenty female Landrace/Large-White pigs, 12-15 weeks of age, were investigated. Asphyxial CA was induced by clamping of the endotracheal tube. After 4min of untreated CA, resuscitation was initiated by unclamping the endotracheal tube, mechanical ventilation, chest compressions and adrenaline (Group A) or a combination of adrenaline with vasopressin (Group A+V) administered intravenously. In case of restoration of spontaneous circulation (ROSC), the animals were monitored for 30min and then observed for 24h.
  
  
  RESULTS
  Hemodynamic variables were measured at baseline during CPR and in the post-resuscitation period. Statistically significant difference was observed in groups A and A+V regarding coronary perfusion pressure (CPP) during the first minute of CPR. In both groups, ROSC and survival rates were comparable (p=NS). Neurological deficit score (NDS) was significantly higher in the combination group 24h following CA (p<0.001). Brain histological damage score (HDS) was also better in the combination group (p<0.001). Total HDS and NDS showed a statistical significant correlation (p<0.001).
  
  
  CONCLUSIONS
  In this porcine model of asphyxial CA, adrenaline alone as well as the combined administration of adrenaline and vasopressin resulted in similar ROSC and survival rates, but the combination of adrenaline and vasopressin resulted in improved neurological and cerebral histopathological outcomes.
authors.affiliation: Department of Experimental Surgery and Surgical Research, University of Athens, Medical School, 11 527 Athens, Greece.
authors.forename: Giolanda
authors.initials: G
authors.lastname: Varvarousi
authors.forename: Elizabeth O
authors.initials: EO
authors.lastname: Johnson
authors.forename: Sotirios
authors.initials: S
authors.lastname: Goulas
authors.forename: Georgios
authors.initials: G
authors.lastname: Agrogiannis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Valsamakis
authors.forename: Despina
authors.initials: D
authors.lastname: Perrea
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.forename: Lila
authors.initials: L
authors.lastname: Papadimitriou
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xanthos
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001237:Asphyxia / Q000150:complications*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D003131:Combined Modality Therapy; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D006439:Hemodynamics; D007262:Infusions, Intravenous; D009422:Nervous System Diseases / Q000517:prevention & control; D011897:Random Allocation; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D015996:Survival Rate; D034421:Sus scrofa; D013552:Swine; D013997:Time Factors; D014667:Vasopressins / Q000008:administration & dosage*
chemical_list: D014667:Vasopressins; D004837:Epinephrine