title: Epinephrine, vasopressin, and nitroglycerin improve neurologic outcome in porcine asphyxial cardiac arrest.
abstract: OBJECTIVE
  The aim of the present study was to assess whether the combination of epinephrine, vasopressin, and nitroglycerin would improve initial resuscitation success, 24-hour survival, and neurologic outcome compared with epinephrine alone in a swine model of asphyxial cardiac arrest (CA).
  
  
  METHODS
  This prospective randomized experimental study was conducted at a laboratory research department. Twenty male Landrace/Large-White pigs 12 to 15 weeks of age were investigated. Asphyxial CA was induced by occlusion of the endotracheal tube. Pigs remained untreated for 4 minutes before attempting resuscitation by unclamping the endotracheal tube, mechanical ventilation, chest compressions, and epinephrine (group E) or a combination of epinephrine with vasopressin and nitroglycerin (group EVN) administered intravenously. In case of restoration of spontaneous circulation, the animals were supported for 30 minutes and then observed for 24 hours.
  
  
  RESULTS
  Coronary perfusion pressure and mean arterial pressure were significantly increased during cardiopulmonary resuscitation in group EVN. In both groups, restoration of spontaneous circulation and survival rates were comparable (P value, nonsignificant). At 24 hours after CA, neurologic deficit score was significantly better in animals treated with the combination pharmacotherapy (P < .001). Brain histologic damage score was also higher in group EVN compared with group E (P < .001). Total histologic damage score and neurologic deficit score showed a statistical significant correlation (P < .001).
  
  
  CONCLUSIONS
  In this porcine model of asphyxial CA, the addition of nitroglycerin to vasopressin and epinephrine maintained elevated coronary perfusion pressure during asphyxia CA and resulted in significantly better neurologic and histopathologic outcome in comparison with epinephrine alone.
authors.affiliation: Department of Experimental Surgery and Surgical Research, University of Athens, Medical School, 11 527 Athens, Greece. gvarvarousi@yahoo.gr
authors.forename: Giolanda
authors.initials: G
authors.lastname: Varvarousi
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: Dimitrios
authors.initials: D
authors.lastname: Iliopoulos
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: D000818:Animals; D001237:Asphyxia / Q000150:complications; D001794:Blood Pressure / Q000187:drug effects; D001921:Brain / Q000473:pathology; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D006323:Heart Arrest / Q000188:drug therapy* / Q000209:etiology; D006339:Heart Rate / Q000187:drug effects; D002534:Hypoxia, Brain / Q000473:pathology / Q000517:prevention & control*; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D013552:Swine; D014667:Vasopressins / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014667:Vasopressins; D005996:Nitroglycerin; D004837:Epinephrine