Vasopressin improves vital organ blood flow during closed-chest cardiopulmonary resuscitation in pigs
Lindner, K.H.; Prengel, A.W.; Pfenninger, E.G.; Lindner, I.M.; Strohmenger, H.U.; Georgieff, M.; Lurie, K.G.
Circulation 91(1): 215-221
1995
ISSN/ISBN: 0009-7322 PMID: 7805205 Document Number: 445061
Background: This study was designed to compare the effects of epinephrine with those of vasopressin on vital organ blood flow during closed-chest cardiopulmonary resuscitation (CPR) in a pig model of ventricular fibrillation. Methods and Results: Vasopressin was compared with epinephrine by randomly allocating 28 pigs to receive either 0.2 mg/kg epinephrine (n=7), 0.2 U/kg vasopressin (low dose) (n=7), 0.4 U/kg vasopressin (medium dose) (n=7), or 0.8 U/kg vasopressin (high dose) (n=7) after 4 minutes of ventricular fibrillation and 3 minutes of closed-chest CPR. Left ventricular myocardial blood flow, determined by use of radiolabeled microspheres during CPR, before and then 90 seconds and 5 minutes after drug administration was 17 +- 2, 43 +- 5, and 22 +- 3 mL cntdot min-1 cntdot 100 g-1 (mean +- SEM) in the epinephrine group; 18 +- 2, 50 +- 6, and 29 +- 3 mL cntdot min-1 cntdot 100 g-1 in the low-dose vasopressin group; 17 +- 3, 52 +- 8, and 52 +- 6 mL cntdot min-1 cntdot 100 g-1 in the medium-dose vasopressin group; and 18 +- 2, 95 +- 9, and 57 +- 6 mL cntdot min-1 cntdot 100 g-1 in the high-dose vasopressin group (P lt .001 at 90 seconds and 5 minutes between epinephrine and high-dose vasopressin, and P lt .01 at 5 minutes between epinephrine and medium-dose vasopressin). At the same times, calculated coronary systolic perfusion pressures were 12 +- 2, 36 +- 5, and 18 +- 2 mm Hg in the epinephrine group; 10 +- 1, 39 +- 6, and 26 +- 5 mm Hg in the low-dose vasopressin group; 11 +- 2, 49 +- 6, and 38 +- 5 mm Hg in the medium-dose vasopressin group; and 10 +- 2, 70 +- 5, and 47 +- 6 mm Hg in the high-dose vasopressin group (P lt .01 at 90 seconds and 5 minutes between epinephrine and high-dose vasopressin); and calculated coronary diastolic perfusion pressures were 15 +- 2, 24 +- 2, and 19 +- 2 mmHg in the epinephrine group; 13 +- 1, 25 +- 2, and 20 +- 1 mmHg in the low-dose vasopressin group; 13 +- 2, 25 +- 2, and 21 +- 2 mmHg in the medium-dose vasopressin group; and 13 +- 2, 35 +- 3, and 24 +- 2 mm Hg in the high-dose vasopressin group (P lt .05 at 90 seconds between epinephrine and high-dose vasopressin). Total cerebral blood flow was significantly higher after high-dose vasopressin than after epinephrine (P lt .05 at 90 seconds and P lt .01 at 5 minutes between groups). Five animals in the epinephrine, 5 in the low-dose vasopressin, 7 in the medium-dose vasopressin, and 6 in the high-dose vasopressin groups were successfully resuscitated and survived the 1-hour observation period. Conclusions: We conclude that administration of vasopressin leads to a significantly higher coronary perfusion pressure and myocardial blood flow than epinephrine during closed-chest CPR in a pig model of ventricular fibrillation.