Chaudhry Ali, O'Reilly Megan, Ramsie Marwa, Lee Tze-Fun, Cheung Po-Yin, Schmölzer Georg M
Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Resusc Plus. 2024 Dec 14;21:100837. doi: 10.1016/j.resplu.2024.100837. eCollection 2025 Jan.
Epinephrine is currently the only recommended cardio-resuscitative medication for use in neonatal cardiopulmonary resuscitation (CPR), as per consensus of science and treatment recommendations. An alternative medication, vasopressin, may be beneficial, however there is limited data regarding its effect on cardiac and brain tissue following recovery from neonatal CPR.
To compare the effects of vasopressin and epinephrine during resuscitation of asphyxiated post-transitional piglets on cardiac and brain tissue injury.
Newborn piglets (n = 10/group) were anesthetized, tracheotomized and intubated, instrumented, and exposed to hypoxia-asphyxia and cardiac arrest. Piglets were randomly allocated to receive intravenous vasopressin (Vaso, 0.4 U/kg) or epinephrine (Epi, 0.02 mg/kg) during CPR until return of spontaneous circulation (ROSC). Left ventricle cardiac tissue, and frontoparietal cerebral cortex and thalamus samples from brain tissue were collected from piglets that survived four hours after ROSC. The concentrations of the pro-inflammatory cytokines interleukin (IL)-1β, IL-6, IL-8, and tumour necrosis factor (TNF)-α, cardiac troponin-1, lactate, and levels of oxidized and total glutathione were quantified in tissue homogenates.
The median time (IQR) to ROSC was 127 (98-162)sec with Vaso and 197 (117-480)sec with Epi (p = 0.07). ROSC rate was 10/10 (100 %) with Vaso and 7/10 (70 %) with Epi (p = 0.21); survival to four hours after ROSC was 10/10 (100 %) with Vaso and 5/7 (71 %) with Epi (p = 0.15). Kaplan-Meier survival curves were significantly different between groups (p = 0.011). Cardiac tissue IL-8 concentration was significantly lower with Vaso than Epi (16.9 (2.94)pg/mg vs. 33.0 (6.75)pg/mg, p = 0.026). All other markers of cardiac and brain tissue injury were similar between Vaso and Epi groups.
Vasopressin is effective in the resuscitation of asphyxiated newborn piglets and is associated with reduced inflammation of the myocardium compared to epinephrine, and there was no evidence of increased tissue injury in the frontoparietal cortex and thalamus regions of the brain. Vasopressin might be a viable alternative to epinephrine during neonatal CPR, but further studies are warranted.
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。然而，另一种药物血管加压素可能有益，但关于其对新生儿CPR复苏后心脏和脑组织的影响的数据有限。
比较血管加压素和肾上腺素在窒息过渡期后仔猪复苏过程中对心脏和脑组织损伤的影响。
将新生仔猪（每组n = 10只）麻醉、气管切开并插管、安装仪器，使其暴露于缺氧窒息和心脏骤停状态。在CPR期间，仔猪被随机分配接受静脉注射血管加压素（Vaso，0.4 U/kg）或肾上腺素（Epi，0.02 mg/kg），直至自主循环恢复（ROSC）。从ROSC后存活4小时的仔猪中采集左心室心脏组织以及额叶顶叶大脑皮层和丘脑的脑组织样本。对组织匀浆中促炎细胞因子白细胞介素（IL）-1β、IL-6、IL-8和肿瘤坏死因子（TNF）-α、心肌肌钙蛋白-1、乳酸以及氧化型和总谷胱甘肽水平进行定量分析。
Vaso组至ROSC的中位时间（IQR）为127（98 - 162）秒，Epi组为197（117 - 480）秒（p = 0.07）。Vaso组的ROSC率为10/10（100%），Epi组为7/10（70%）（p = 0.21）；ROSC后存活至4小时的比例，Vaso组为10/10（100%），Epi组为5/7（71%）（p = 0.15）。两组间的Kaplan-Meier生存曲线有显著差异（p = 0.011）。Vaso组心脏组织中IL-8浓度显著低于Epi组（16.9（2.94）pg/mg对33.0（6.75）pg/mg，p = 0.026）。Vaso组和Epi组之间所有其他心脏和脑组织损伤指标相似。
血管加压素对窒息新生仔猪的复苏有效，与肾上腺素相比，可减轻心肌炎症，且没有证据表明脑额叶顶叶皮层和丘脑区域的组织损伤增加。在新生儿CPR期间，血管加压素可能是肾上腺素的一种可行替代药物，但仍需进一步研究。
