Effect of vasopressin on brain and cardiac tissue during neonatal cardiopulmonary resuscitation of asphyxiated post-transitional piglets
Background
Epinephrine remains the cornerstone medication for neonatal cardiopulmonary resuscitation (CPR), endorsed by consensus-based science and treatment guidelines. However, the search for alternative interventions has raised interest in vasopressin as a potential candidate. Despite its theoretical benefits, the effects of vasopressin on cardiac and brain tissues after neonatal CPR recovery remain largely unexplored.
Aim
This study aimed to evaluate and compare the impact of vasopressin and epinephrine on cardiac and brain tissue injury during resuscitation of asphyxiated post-transitional piglets. The investigation focused on their effectiveness in achieving return of spontaneous circulation (ROSC) and their influence on inflammation and oxidative stress markers in critical tissues.
Methods
Newborn piglets (n = 10 per group) underwent anesthesia, tracheotomy, and intubation before being subjected to hypoxia-asphyxia and cardiac arrest. During CPR, the piglets were randomly assigned to receive intravenous vasopressin (Vaso, 0.4 U/kg) or epinephrine (Epi, 0.02 mg/kg) until ROSC. Tissue samples from the left ventricle (cardiac tissue) and frontoparietal cerebral cortex and thalamus (brain tissue) were collected from survivors at four hours post-ROSC.
The study measured:
Pro-inflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α)
Cardiac troponin-1 and lactate levels
Oxidized and total glutathione concentrations
Main Results
ROSC Time: Median ROSC time was faster with vasopressin [127 seconds (IQR: 98–162)] compared to epinephrine [197 seconds (IQR: 117–480)], though the difference was not statistically significant (p = 0.07).
ROSC and Survival Rates: Vasopressin achieved a 100% ROSC rate (10/10) and survival at four hours, compared to 70% ROSC (7/10) and 71% survival (5/7) with epinephrine. Kaplan-Meier survival curves showed a significant difference favoring vasopressin (p = 0.011).
Inflammatory Markers: IL-8 concentrations in cardiac tissue were significantly lower in the vasopressin group [16.9 pg/mg (SD: 2.94)] compared to the epinephrine group [33.0 pg/mg (SD: 6.75), p = 0.026]. Other markers of cardiac and brain tissue injury did not differ significantly between groups.
Conclusions
Vasopressin demonstrated effectiveness in resuscitating asphyxiated newborn piglets, with a faster time to ROSC, higher survival rates, and reduced cardiac inflammation compared to epinephrine. Importantly, vasopressin did not increase brain tissue injury in the frontoparietal cortex or thalamus, suggesting it may be a safe and viable alternative in neonatal CPR.
Implications for Future Research
The findings highlight vasopressin's potential as an alternative to epinephrine during neonatal resuscitation. However, additional studies, particularly in human neonates, are essential to validate these results and establish guidelines for clinical use.
This study not only broadens our understanding of vasopressin's role in neonatal resuscitation but also underscores the importance of exploring innovative approaches to improve outcomes in this critical population.
This study is another part of the VERSE-Trial
