Neural injury after use of vasopressin and adrenaline during porcine cardiopulmonary resuscitation

Abstract

Background Our aim was to investigate cerebral and cardiac tissue injury subsequent to use of vasopressin and adrenaline in combination compared with vasopressin alone during cardiopulmonary resuscitation (CPR).Methods In a randomized, prospective, laboratory animal study 28 anesthetized piglets were subject to a 12-min untreated cardiac arrest and subsequent CPR. After 1 min of CPR, 10 of the piglets received 0.4 U/kg of arg8-vasopressin (V group), and 10 piglets received 0.4 U/kg of arg8-vasopressin, 1 min later followed by 20 µg/kg body weight of adrenaline, and another 1 min later continuous administration (10 µg/kg/min) of adrenaline (VA group). After 8 min of CPR, the piglets were defibrillated and monitored for another 3 h. Then they were killed and the brain immediately removed pending histological analysis.Results During CPR, the VA group had higher mean blood pressure and cerebral cortical blood flow (CCBF) but similar coronary perfusion pressure. After restoration of spontaneous circulation there was no difference in the pressure variables, but CCBF tended to be (36% ± 16%) higher in the V group. Neuronal injury and signs of a disrupted blood–brain barrier (BBB) were greater, 20% ± 4% and 21% ± 4%, respectively, in the VA group. In a background study of repeated single doses of adrenaline every third minute after 5 min arrest but otherwise the same protocol, histological measurements showed even worse neural injury and disruption of the BBB.Conclusion Combined use of vasopressin and adrenaline caused greater signs of cerebral and cardiac injury than use of vasopressin alone during experimental cardiopulmonary resuscitation.

Non-invasive diffuse optical neuromonitoring during cardiopulmonary resuscitation predicts return of spontaneous circulation

“…An asphyxial injury was selected to model the predominant respiratory-mediated etiology of pediatric in-hospital arrests 13,45 . The relative comparability of chest mechanics 46 and brain size, development and physiology 47,48 of pediatric swine motivated their use, by our group and others, for CPR studies of neurological injury [6][7][8][9][10][11]49,50 , as well as in FD-DOS validation studies 22,23,41 . A neonatal swine model of post-hypoxic encephalopathy 51 demonstrated similar clinical, electrophysiological, and neuropathological findings to term infants suggesting comparable physiologic response and injury susceptibility to hypoxia.…”

The Effect of Prehospital Epinephrine in Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

“…This was supported by animal studies where the epinephrine reduced capillary blood flow to swine brain. 34,40,41 Neurologic outcomes at hospital discharge are a subjective assessment based on cerebral performance category. In this review, the authors were unable to demonstrate any associations between poor neurologic prognosis with the duration of brain hypoxia, dosage, and timing of administration epinephrine.…”

The role of adrenaline in cardiopulmonary resuscitation

“…In another study, piglets were randomised to vasopressin, or vasopressin and adrenaline, with the adrenaline given by bolus (20 μg/kg) followed by infusion (10 μg/kg/min) [ 7 ]. Although the adrenaline with vasopressin group had higher mean blood pressure ( p = 0.03) and CBF ( p < 0.05) during CPR, after resuscitation the CBF was numerically 36% lower, although this was not statistically significant ( p = 0.06).…”