McNamara Patrick J, Engelberts Doreen, Finelli Michael, Adeli Khosrow, Kavanagh Brian P
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.
Physiology and Experimental Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatr Res. 2014 Jun;75(6):738-48. doi: 10.1038/pr.2014.38. Epub 2014 Mar 10.
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).
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.
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).
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.
肾上腺素是所有复苏算法的组成部分。血管加压素是一种肺血管扩张剂和全身血管加压剂。我们研究了肾上腺素与血管加压素对新生猪心脏骤停（CA）后生存及血流动力学的影响。
诱导4分钟窒息性心脏骤停，之后开始心肺复苏（CPR）。将动物随机分为低剂量肾上腺素组（LDE：0.01mg/kg）、高剂量肾上腺素组（HDE：0.03mg/kg）、低剂量血管加压素组（LDV：0.2U/kg）、高剂量血管加压素组（HDV：0.4U/kg）或对照组（生理盐水）。监测临床和超声心动图指标。
69只动物被随机分组。与对照组（n = 7（43%））和LDE组（n = 5（36%））相比，HDV组（n = 8（89%））的生存率更高（方差分析，P < 0.05），但与HDE组（n = 7（64%））和LDV组（n = 6（75%））相比无差异。接受LDE复苏的动物需要更多电击（2.5（四分位数间距：2 - 6）；P < 0.05）和更高剂量的能量（15J（四分位数间距：10 - 20）；P < 0.05）。各组左心室输出相当，但HDV后上腔静脉血流增加更明显（与对照组、LDE组和HDE组相比，P < 0.001）。HDE组血浆肌钙蛋白最高（与对照组和HDV组相比，P < 0.05）。
血管加压素可提高新生仔猪心脏骤停后的生存率，降低复苏后肌钙蛋白水平，并减少血流动力学损害。血管加压素可能是用于人类新生儿试验的候选药物。
