窒息性过渡后仔猪新生儿心肺复苏期间血管加压素与肾上腺素的比较
Vasopressin versus epinephrine during neonatal cardiopulmonary resuscitation of asphyxiated post-transitional piglets.
作者信息
O'Reilly Megan, Lee Tze-Fun, Cheung Po-Yin, Schmölzer Georg M
机构信息
Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
出版信息
Resusc Plus. 2023 Jul 17;15:100427. doi: 10.1016/j.resplu.2023.100427. eCollection 2023 Sep.
BACKGROUND
Epinephrine is currently the only recommended cardio-resuscitative medication for use in neonatal cardiopulmonary resuscitation (CPR), as per the consensus of science and treatment recommendations. An alternative medication, vasopressin, might be beneficial in neonatal CPR due to its combined pulmonary vasodilation and systemic vasoconstriction properties.
AIM
We aimed to compare the time to return of spontaneous circulation (ROSC) with administration of vasopressin or epinephrine during CPR of asphyxiated post-transitional piglets.
METHODS
Newborn piglets ( = 8/group) were anesthetized, tracheotomized and intubated, instrumented, and exposed to 50 min normocapnic hypoxia followed by asphyxia and cardiac arrest. Piglets were randomly allocated to receive vasopressin (Vaso, 0.4 U/kg) or epinephrine (Epi, 0.02 mg/kg) during CPR. Piglets were resuscitated with chest compressions superimposed with sustained inflations, and were administered either Vaso or Epi intravenously every 3 min until ROSC (max. 3 doses). Hemodynamic and cardiac function parameters were collected.
MAIN RESULTS
The median (IQR) time to ROSC was 106 (93-140) s with Vaso and 128 (100-198) s with Epi ( = 0.28). The number of piglets that achieved ROSC was 8 (100%) with Vaso and 7 (88%) with Epi ( = 1.00). Vaso-treated piglets had a significantly longer post-resuscitation survival time (240 (240-240) min) than Epi-treated piglets (65 (30-240) min, = 0.02). Vaso-treated piglets had significantly improved carotid blood flow immediately after ROSC ( < 0.05), had longer duration of post-resuscitation hypertension ( = 0.05), and had significantly improved heart rate, arterial pressure, and cerebral blood oxygen saturation 4 h after ROSC ( < 0.05).
CONCLUSIONS
Vasopressin improved post-resuscitation survival and hemodynamics, and might be an alternative cardio-resuscitative medication during neonatal CPR, but further studies are warranted.
背景
根据科学共识和治疗建议，肾上腺素是目前新生儿心肺复苏（CPR）中唯一推荐使用的心脏复苏药物。另一种药物血管加压素，因其兼具肺血管舒张和全身血管收缩特性，可能对新生儿心肺复苏有益。
目的
我们旨在比较窒息性过渡期后仔猪心肺复苏期间使用血管加压素或肾上腺素后自主循环恢复（ROSC）的时间。
方法
将新生仔猪（每组 = 8 只）麻醉、气管切开并插管、安装监测仪器，使其经历 50 分钟的正常碳酸血症性缺氧，随后发生窒息和心脏骤停。仔猪在心肺复苏期间被随机分配接受血管加压素（Vaso，0.4 U/kg）或肾上腺素（Epi，0.02 mg/kg）。通过胸外按压叠加持续通气对仔猪进行复苏，每 3 分钟静脉注射 Vaso 或 Epi，直至恢复自主循环（最大 3 剂）。收集血流动力学和心脏功能参数。
主要结果
使用 Vaso 后恢复自主循环的中位（IQR）时间为 106（93 - 140）秒，使用 Epi 后为 128（100 - 198）秒（P = 0.28）。达到自主循环的仔猪数量，使用 Vaso 组为 8 只（100%），使用 Epi 组为 7 只（88%）（P = 1.00）。接受 Vaso 治疗的仔猪复苏后的存活时间（240（240 - 240）分钟）明显长于接受 Epi 治疗的仔猪（65（30 - 240）分钟，P = 0.02）。接受 Vaso 治疗的仔猪在恢复自主循环后立即颈动脉血流量显著改善（P < 0.05），复苏后高血压持续时间更长（P = 0.05），并且在恢复自主循环 4 小时后心率、动脉压和脑血氧饱和度显著改善（P < 0.05）。
结论
血管加压素改善了复苏后的存活率和血流动力学，可能是新生儿心肺复苏期间的一种替代性心脏复苏药物，但仍需进一步研究。
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