Rawat Munmun, Gugino Sylvia, Koenigsknecht Carmon, Helman Justin, Nielsen Lori, Sankaran Deepika, Nair Jayasree, Chandrasekharan Praveen, Lakshminrusimha Satyan
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA.
Department of Pediatrics, UC Davis Medical Center, Sacramento, CA 95817, USA.
Children (Basel). 2023 Feb 10;10(2):349. doi: 10.3390/children10020349.
Current neonatal resuscitation guidelines recommend the use of epinephrine for bradycardia/arrest not responding to ventilation and chest compressions. Vasopressin is a systemic vasoconstrictor and is more effective than epinephrine in postnatal piglets with cardiac arrest. There are no studies comparing vasopressin with epinephrine in newly born animal models with cardiac arrest induced by umbilical cord occlusion. To compare the effect of epinephrine and vasopressin on the incidence and time to return of spontaneous circulation (ROSC), hemodynamics, plasma drug levels, and vasoreactivity in perinatal cardiac arrest. Twenty-seven term fetal lambs in cardiac arrest induced by cord occlusion were instrumented and resuscitated following randomization to epinephrine or vasopressin through a low umbilical venous catheter. Eight lambs achieved ROSC prior to medication. Epinephrine achieved ROSC in 7/10 lambs by 8 ± 2 min. Vasopressin achieved ROSC in 3/9 lambs by 13 ± 6 min. Plasma vasopressin levels in nonresponders were much lower than responders after the first dose. Vasopressin caused in vivo increased pulmonary blood flow and in vitro coronary vasoconstriction. Vasopressin resulted in lower incidence and longer time to ROSC compared to epinephrine in a perinatal model of cardiac arrest supporting the current recommendations for exclusive use of epinephrine in neonatal resuscitation.
当前的新生儿复苏指南建议，对于对通气和胸外按压无反应的心动过缓/心脏骤停，使用肾上腺素。血管加压素是一种全身性血管收缩剂，在新生仔猪心脏骤停模型中比肾上腺素更有效。尚无研究比较血管加压素与肾上腺素在脐带闭塞诱导的新生动物心脏骤停模型中的效果。本研究旨在比较肾上腺素和血管加压素对围产期心脏骤停时自主循环恢复（ROSC）的发生率和恢复时间、血流动力学、血浆药物水平及血管反应性的影响。27只因脐带闭塞导致心脏骤停的足月胎羊，通过低位脐静脉导管随机给予肾上腺素或血管加压素后进行仪器监测和复苏。8只羔羊在用药前实现了自主循环恢复。肾上腺素使10只羔羊中的7只在8±2分钟时实现自主循环恢复。血管加压素使9只羔羊中的3只在13±6分钟时实现自主循环恢复。首剂用药后，未恢复自主循环者的血浆血管加压素水平远低于恢复自主循环者。血管加压素在体内可增加肺血流量，在体外可引起冠状动脉血管收缩。在围产期心脏骤停模型中，与肾上腺素相比，血管加压素导致自主循环恢复的发生率更低、时间更长，这支持了目前新生儿复苏中仅使用肾上腺素的建议。
