title: Adrenaline, terlipressin, and corticoids versus adrenaline in the treatment of experimental pediatric asphyxial cardiac arrest.
abstract: OBJECTIVE
  To analyze if treatment with adrenaline (epinephrine) plus terlipressin plus corticoids achieves higher return of spontaneous circulation than adrenaline in an experimental infant animal model of asphyxial cardiac arrest.
  
  
  METHODS
  Prospective randomized animal study.
  
  
  METHODS
  Experimental department in a University Hospital.
  
  
  METHODS
  Forty-nine piglets were studied.
  
  
  METHODS
  Cardiac arrest was induced by at least 10 minutes of removal of mechanical ventilation and was followed by manual external chest compressions and mechanical ventilation. After 3 minutes of resuscitation, piglets that did not achieve return of spontaneous circulation were randomized to two groups: adrenaline 0.02 mg kg every 3 minutes (20 animals) and adrenaline 0.02 mg kg every 3 minutes plus terlipressin 20 μg kg every 6 minutes plus hydrocortisone 30 mg kg one dose (22 animals). Resuscitation was discontinued when return of spontaneous circulation was achieved or after 24 minutes.
  
  
  RESULTS
  Return of spontaneous circulation was achieved in 14 piglets (28.5%), 14.2% with only cardiac massage and ventilation. Return of spontaneous circulation was achieved in 25% of piglets treated with adrenaline and in 9.1% of those treated with adrenaline plus terlipressin plus hydrocortisone (p = 0.167). Return of spontaneous circulation was achieved in 45.4% of animals with pulseless electric activity, 20% with asystole, and 0% with ventricular fibrillation (p = 0.037). Shorter duration of cardiac arrest, higher mean blood pressure and EtCO2 and lower PaCO2 before resuscitation, and higher mean blood pressure during resuscitation were associated with higher return of spontaneous circulation.
  
  
  CONCLUSIONS
  Treatment with adrenaline plus terlipressin plus corticoids does not achieve higher return of spontaneous circulation than that with adrenaline in an infant animal model of asphyxial cardiac arrest.
authors.affiliation: 1Paediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 2Instituto de Investigación del Hospital General Universitario Gregorio Marañón, Madrid, Spain. 3Spanish Health Institute Carlos III. Maternal, Child Health and Development Network, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: González
authors.forename: Javier
authors.initials: J
authors.lastname: Urbano
authors.forename: Marta
authors.initials: M
authors.lastname: Botrán
authors.forename: Jorge
authors.initials: J
authors.lastname: López
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Solana
authors.forename: Ana
authors.initials: A
authors.lastname: García
authors.forename: Sarah
authors.initials: S
authors.lastname: Fernández
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000818:Animals; D001237:Asphyxia / Q000150:complications; D001775:Blood Circulation; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D016887:Cardiopulmonary Resuscitation; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000627:therapeutic use*; D006323:Heart Arrest / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010313:Partial Pressure; D011446:Prospective Studies; D011897:Random Allocation; D013552:Swine; D000077585:Terlipressin; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D014662:Vasoconstrictor Agents; D002245:Carbon Dioxide; D008236:Lypressin; D000077585:Terlipressin; D004837:Epinephrine