title: Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest.
abstract: BACKGROUND
  Epinephrine is a component of all resuscitation algorithms. Vasopressin is a pulmonary vasodilator and systemic vasopressor. We investigated the effect of epinephrine vs. vasopressin on survival and hemodynamics after neonatal porcine cardiac arrest (CA).
  
  
  METHODS
  A 4-min asphyxial CA was induced, after which cardiopulmonary resuscitation (CPR) was commenced. Animals were randomized to low- (LDE: 0.01 mg/kg) or high-dose epinephrine (HDE: 0.03 mg/kg), low- (LDV: 0.2 U/kg) or high-dose vasopressin (HDV: 0.4 U/kg), or control (saline). Clinical and echocardiography indexes were monitored.
  
  
  RESULTS
  Sixty-nine animals were randomized. Survival was greater in HDV (n = 8 (89%); P < 0.05 ANOVA) vs. control (n = 7 (43%)) and LDE (n = 5 (36%)) but not vs. HDE (n = 7 (64%)) or LDV (n = 6 (75%)). Animals resuscitated with LDE required more shocks (2.5 (interquartile range: 2-6); P < 0.05) and higher doses of energy (15 J (interquartile range: 10-20); P < 0.05). Left ventricular output was comparable between groups, but a greater increase in superior vena caval flow was seen after HDV (P < 0.001 vs. control, LDE, and HDE). Plasma troponin was greatest in the HDE group (P < 0.05 vs. control and HDV).
  
  
  CONCLUSIONS
  Vasopressin results in improved survival, lower postresuscitation troponin, and less hemodynamic compromise after CA in newborn piglets. Vasopressin may be a candidate for testing in human neonates.
authors.affiliation: 1] Division of Neonatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada [2] Physiology and Experimental Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McNamara
authors.affiliation: Physiology and Experimental Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Doreen
authors.initials: D
authors.lastname: Engelberts
authors.affiliation: Department of Respiratory Therapy, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Finelli
authors.affiliation: Division of Clinical Biochemistry, Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Khosrow
authors.initials: K
authors.lastname: Adeli
authors.affiliation: Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Kavanagh
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D000831:Animals, Newborn; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D004837:Epinephrine / Q000494:pharmacology / Q000627:therapeutic use*; D006323:Heart Arrest / Q000188:drug therapy*; D013552:Swine; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D014667:Vasopressins / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D014336:Troponin; D014667:Vasopressins; D004837:Epinephrine