High dose versus standard dose epinephrine in cardiac arrest — a meta-analysis

Vandycke, Carine; Martens, Patrick

doi:10.1016/s0300-9572(00)00188-x

Cited by 119 publications

(58 citation statements)

References 24 publications

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“…To detect an incremental mortality difference of 35% between saline-treated and epinephrine-treated animals, with an α of 0.05 and 80% power (Yates correction applied), a convenience sample of eight animals per group was required. This expected mortality difference is based on the mortality difference noted in our previous experiments (19) and previous pilot data. The primary outcome was survival.…”

Section: Vasopressin and Neonatal Resuscitationmentioning

confidence: 81%

“…All two-dimensional echo studies were performed by the principal investigator (P.J.McN. ), who is experienced with animal echocardiography (17)(18)(19). Animals were examined in the supine position, and the transducer was gently applied to the chest, with a depth and frame rate, chosen to obtain the highest quality images.…”

Section: Vasopressin and Neonatal Resuscitationmentioning

confidence: 99%

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Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest

et al. 2014

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Background: 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). Methods: 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. results: 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). conclusion: 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. t he need for active neonatal resuscitation is common with an incidence of 5-10%, although there is likely to be regional variability (1). Guidelines for drug use in neonatal resuscitation guidelines are based on extrapolations from adult literature. Pressors, almost invariably epinephrine, are recommended as core therapy during cardiopulmonary resuscitation (CPR) in order to enhance systemic perfusion (especially cerebral and coronary perfusion) by maintaining vascular tone while forward flow is generated by chest compressions. Epinephrine, although an integral part of every published protocol for neonatal resuscitation, may be associated with adverse effects (2-6); similar concerns exist in pediatric and adult cardiac arrest (CA). However, because of concerns associated with epinephrine (2,7), vasopressin was studied in the setting of asystolic CA. Vasopressin is an intense systemic vasoconstrictor, which may explain why it increases cerebral (and systemic) perfusion during experimental cardiac massage, as well as increasing cerebral oxygenation, neurological outcome, and resuscitation success following experimental .Vasopressin was first proposed as a resuscitation agent after endogenous vasopressin levels were found to be higher in successfully resuscitated patients compared with those who died (13). Evidence from a large, adult, multicenter, randomized controlled trial suggests it to be superior to epinephrine, when the nature of the CA was primary asystole (14). For the following reasons, vasopressin may be a good candidate for pressor support during CPR. First, CA in neonates is almost always due to asphy...

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Section: Vasopressin and Neonatal Resuscitationmentioning

confidence: 81%

Section: Vasopressin and Neonatal Resuscitationmentioning

confidence: 99%

Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest

et al. 2014

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“…Múltiples series clínicas y reportes de casos sugieren que tanto fluidos como la medicación pueden ser administrados exitosamente por vía intraósea durante la reanimación de recién nacidos cuando no se cuenta con el equipo o las habilidades necesarias para establecer un acceso venoso o si no puede establecerse en pocos minutos. 106,107 cuidados posT reaniMación Hipertermia Se ha reportado que niños nacidos de madres febriles han presentado mayor incidencia de convulsiones, depresión respiratoria perinatal, pará-lisis cerebral y aumento del riesgo de mortalidad. Sin embargo no hay evidencia que determine que la causa de esto sea la fiebre en sí misma o la noxa que la provocó.…”

Section: Acceso Vascularunclassified

Recomendaciones en Reanimación Neonatal 2011. 3a parte: Medicación y expansores de volumen. Cuidados post reanimación. Aspectos éticos

CEFEN¹

2012

Arch Argent Pediat

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Medicación y expansores de voluMen adrenalinaRara vez está indicada la administración de drogas en la reanimación de un recién nacido. En ellos la bradicardia es generalmente el resultado de una inadecuada expansión pulmonar con hipoxemia grave. Establecer una ventilación adecuada es el paso más importante para corregirla. Sin embargo, si la frecuencia cardíaca permanece menor a 60 lpm a pesar de una ventilación adecuada (generalmente a través del TET) con oxígeno al 100% y masaje cardíaco, puede estar indicada la administración de adrenalina, expansores de volumen, o ambos. El bicarbonato, los antagonistas de opioides y los vasopresores raramente son útiles en reanimación. El uso de éstos no está recomendado en la sala de partos. administración, rango y dosisEn cuanto a la vía de administración, se recomienda la administración de adrenalina en forma endovenosa.

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“…44 A meta-analysis of high-dose versus standard-dose epinephrine RCTs failed to show a statistical difference. 45 Several other drugs have experienced encouraging animal results, but, to the best of our knowledge, no drug has been reliably proven to increase human survival to hospital discharge following cardiac arrest. 46 The use of medical antishock trousers (MAST) became ubiquitous during the 1970s and 1980s without strong evidence of effectiveness.…”

Section: Implications For Future Ems Outcomes Researchmentioning

confidence: 99%

Establishing the Scope and Methodological Approach to Out‐of‐hospital Outcomes and Effectiveness Research

Keim

Spaite

Maio

et al. 2004

Academic Emergency Medicine

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Outcomes research offers out-of-hospital medicine a valuable methodology for studying the effectiveness of services provided in the out-of hospital setting. A clear understanding of the history and constructs of outcomes research is necessary for its integration into emergency medical services research. This report describes the conceptual framework of outcomes research and key methodological considerations for the successful implementation of out-ofhospital outcomes research. Illustrations of the specific applications of outcomes research and implications to existing methodologies are given, as well as suggestions for improved interdisciplinary research.

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High dose versus standard dose epinephrine in cardiac arrest — a meta-analysis

Cited by 119 publications

References 24 publications

Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest

Vasopressin improves survival compared with epinephrine in a neonatal piglet model of asphyxial cardiac arrest

Recomendaciones en Reanimación Neonatal 2011. 3a parte: Medicación y expansores de volumen. Cuidados post reanimación. Aspectos éticos

Establishing the Scope and Methodological Approach to Out‐of‐hospital Outcomes and Effectiveness Research

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