Comparison of epinephrine and vasopressin in a pediatric porcine model of asphyxial cardiac arrest

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Abstract
This study was designed to compare the effects of vasopressin vs. epinephrine vs. the combination of epinephrine with vasopressin on vital organ blood flow and return of spontaneous circulation in a pediatric porcine model of asphyxial arrest. Prospective, randomized laboratory investigation using an established porcine model for measurement of hemodynamic variables, organ blood flow, blood gases, and return of spontaneous circulation. University hospital laboratory. Eighteen piglets weighing 8–11 kg. Asphyxial cardiac arrest was induced by clamping the endotracheal tube. After 8 mins of cardiac arrest and 8 mins of cardiopulmonary resuscitation, a bolus dose of either 0.8 units/kg vasopressin (n = 6), 200 μg/kg epinephrine (n = 6), or a combination of 45 μg/kg epinephrine with 0.8 units/kg vasopressin (n = 6) was administered in a randomized manner. Defibrillation was attempted 6 mins after drug administration. Mean ± sem coronary perfusion pressure, before and 2 mins after drug administration, was 13 ± 2 and 23 ± 6 mm Hg in the vasopressin group; 14 ± 2 and 31 ± 4 mm Hg in the epinephrine group; and 13 ± 1 and 33 ± 6 mm Hg in the epinephrine-vasopressin group, respectively (p = NS). At the same time points, mean ± sem left ventricular myocardial blood flow was 44 ± 31 and 44 ± 25 mL·min−1·100 g−1 in the vasopressin group; 30 ± 18 and 233 ± 61 mL·min−1·100 g−1 in the epinephrine group; and 36 ± 10 and 142 ± 57 mL·min−1·100 g−1 in the epinephrine-vasopressin group (p p Administration of epinephrine, either alone or in combination with vasopressin, significantly improved left ventricular myocardial blood flow during cardiopulmonary resuscitation. Return of spontaneous circulation was significantly more likely in epinephrine-treated pigs than in animals resuscitated with vasopressin alone.