Effects of epinephrine and vasopressin in a piglet model of prolonged ventricular fibrillation and cardiopulmonary resuscitation

OBJECTIVEWe recently demonstrated that vasopressin alone resulted in a poorer outcome in a pediatric porcine model of asphyxial cardiac arrest when compared with epinephrine alone or with epinephrine plus vasopressin in combination. Accordingly, this study was designed to differentiate whether the inferior effects of vasopressin in pediatrics were caused by the type of cardiac arrest. DESIGNProspective, randomized laboratory investigation that used an established porcine model for measurement of hemodynamic variables and organ blood flow. SETTINGUniversity hospital laboratory. SUBJECTSEighteen piglets weighing 8–11 kg. INTERVENTIONSAfter 8 mins of ventricular fibrillation and 8 mins of cardiopulmonary resuscitation, either 0.4 units/kg vasopressin (n = 6), 45 μg/kg epinephrine (n = 6), or a combination of 45 μg/kg epinephrine with 0.8 units/kg vasopressin (n = 6) was administered. Six minutes after drug administration, a second respective bolus dose of 0.8 units/kg vasopressin, 200 μg/kg epinephrine, or a combination of 200 μg/kg epinephrine with 0.8 units/kg vasopressin was given. Defibrillation was attempted 20 mins after initiating cardiopulmonary resuscitation. MEASUREMENTS AND MAIN RESULTSMean ± sem left ventricular myocardial blood flow 2 mins after each respective drug administration was 65 ± 4 and 70 ± 13 mL·min·100 g in the vasopressin group; 83 ± 42 and 85 ± 41 mL·min·100 g in the epinephrine group; and 176 ± 32 and 187 ± 29 mL·min·100 g in the epinephrine-vasopressin group (p < .006 after both doses of epinephrine-vasopressin vs. vasopressin and after the first dose of epinephrine-vasopressin vs. epinephrine, respectively). At the same times, mean ± sem total cerebral blood flow was 73 ± 3 and 47 ± 5 mL·min·100 g after vasopressin; 18 ± 2 and 12 ± 2 mL·min·100 g after epinephrine; and 79 ± 21 and 41 ± 8 mL·min·100 g after epinephrine-vasopressin (p < .025 after both doses of vasopressin and epinephrine-vasopressin vs. epinephrine). Five of six vasopressin-treated, two of six epinephrine-treated, and six of six epinephrine-vasopressin treated animals had return of spontaneous circulation (nonsignificant). CONCLUSIONSIn this pediatric porcine model of ventricular fibrillation, the combination of epinephrine with vasopressin during cardiopulmonary resuscitation resulted in significantly higher levels of left ventricular myocardial blood flow than either vasopressin alone or epinephrine alone. Both vasopressin alone and the combination of epinephrin