Addition of glucagon to adrenaline improves hemodynamics in a porcine model of prolonged ventricular fibrillation.
OBJECTIVE
Cardiac arrest is a daunting medical emergency. The aim of the present study was to assess whether the combination of adrenaline and glucagon would improve initial resuscitation success, 48-hour survival, and neurologic outcome compared with adrenaline alone in a porcine model of ventricular fibrillation.


METHODS
Ventricular fibrillation was induced in 20 healthy Landrace/Large White piglets, which were subsequently left untreated for 8 minutes. The animals were randomized to receive adrenaline alone (n = 10, group C) and adrenaline plus glucagon (n = 10, group G). All animals were resuscitated according to the 2010 European Resuscitation Council guidelines. Hemodynamic variables were measured before arrest, during arrest and resuscitation, and during the first 60 minutes after return of spontaneous circulation. Survival and a neurologic alertness score were measured at 48 hours after return of spontaneous circulation.


RESULTS
Return of spontaneous circulation was achieved in 8 animals (80%) from group C and 10 animals (100%) from group G (P = .198). A significant gradual increase in coronary perfusion pressure and diastolic aortic pressure over time, which started 1 minute after the onset of cardiopulmonary resuscitation, was observed. Three animals (30%) from group C and 9 animals (90%) from group G survived after 48 hours (P = .006), whereas neurologic examination was significantly better in the animals of group G (P < .001).


CONCLUSIONS
In this porcine model of prolonged ventricular fibrillation, the addition of glucagon to adrenaline improves hemodynamics during resuscitation and early postresuscitation period and may increase survival.
Emergency Medicine, Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, AP Vojvodina, Serbia.
Violetta
V
Raffay
National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece. Electronic address: thanoschalkias@yahoo.gr.
Athanasios
A
Chalkias
National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
Pavlos
P
Lelovas
National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
Georgios
G
Karlis
National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
Anastasios
A
Koutsovasilis
Experimental-Research Center "ELPEN" Pharmaceutical Co, Athens, Greece.
Apostolos
A
Papalois
University of Kragujevac, Medical School, Center for Anesthesiology and Resuscitation, Clinical Center Kragujevac, Kragujevac, Serbia.
Jasna
J
Jevdjic
Emergency Medicine, Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, AP Vojvodina, Serbia.
Zlatko
Z
Fiser
National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
Theodoros
T
Xanthos
D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005934:Glucagon / Q000008:administration & dosage / Q000627:therapeutic use*; D006323:Heart Arrest / Q000188:drug therapy / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D008297:Male; D013552:Swine; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000503:physiopathology
D005934:Glucagon; D004837:Epinephrine