Resuscitation with amiodarone increases survival after hemorrhage and ventricular fibrillation in pigs.
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BACKGROUND
The aim of this experimental study was to compare survival and hemodynamic effects of a low-dose amiodarone and vasopressin compared with vasopressin in hypovolemic cardiac arrest model in piglets.


METHODS
Eighteen anesthetized male piglets (with a weight of 25.3 [1.8] kg) were bled approximately 30% of the total blood volume via the femoral artery to a mean arterial blood pressure of 35 mm Hg in a 15-minute period. Afterward, the piglets were subjected to 4 minutes of untreated ventricular fibrillation followed by 11 minutes of open-chest cardiopulmonary resuscitation. At 5 minutes, circulatory arrest amiodarone 1 mg/kg was intravenously administered in the amiodarone group (n = 9), while the control group received the same amount of saline (n = 9). At the same time, all piglets received vasopressin 0.4 U/kg intravenously administered and hypertonic-hyperoncotic solution 3-mL/kg infusion for 20 minutes. Internal defibrillation was attempted from 7 minutes of cardiac arrest to achieve restoration of spontaneous circulation. The experiment was terminated 3 hours after resuscitation.


RESULTS
Three-hour survival was greater in the amiodarone group (p = 0.02). After the successful resuscitation, the amiodarone group piglets had significantly lower heart rate as well as greater systolic, diastolic, and mean arterial pressure. Troponin I plasma concentrations were lower and urine output was greater in the amiodarone group.


CONCLUSIONS
Combined resuscitation with amiodarone and vasopressin after hemorrhagic circulatory arrest resulted in greater 3-hour survival, better preserved hemodynamic parameters, and smaller myocardial injury compared with resuscitation with vasopressin only.
From the Department of Operative and Intensive Care Medicine (F.Z.), Hallands Hospital Halmstad, Halmstad; and Department of Surgical Sciences/Anaesthesiology and Intensive Care (E.S.), Faculty of Medicine, Uppsala University, Uppsala, Sweden.
Frank
F
Zoerner
Egidijus
E
Semenas
D000638:Amiodarone / Q000008:administration & dosage*; D000818:Animals; D050034:Antidiuretic Agents / Q000008:administration & dosage; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000187:drug effects*; D006470:Hemorrhage / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D007275:Injections, Intravenous; D008297:Male; D012151:Resuscitation / Q000379:methods*; D013552:Swine; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage; D014667:Vasopressins / Q000008:administration & dosage; D014693:Ventricular Fibrillation / Q000150:complications* / Q000401:mortality / Q000503:physiopathology
D050034:Antidiuretic Agents; D014665:Vasodilator Agents; D014667:Vasopressins; D000638:Amiodarone