Effects of various vasopressin doses compared to epinephrine during neonatal CPR

BACKGROUND: Current neonatal resuscitation guidelines recommend epinephrine for cardiac arrest. Vasopressin might be an alternative during asphyxial cardiac arrest. We aimed to compare vasopressin and epinephrine on incidence and time to return of spontaneous circulation (ROSC) in asphyxiated newborn piglets.

DESIGN/METHODS: Newborn piglets (n = 8/group) were anesthetized, intubated, instrumented, and exposed to 30 min of normocapnic hypoxia, followed by asphyxia and asystolic cardiac arrest. Piglets were randomized to 0.2, 0.4, or 0.8IU/kg vasopressin, or 0.02 mg/kg epinephrine. Hemodynamic parameters were continuously measured.

RESULTS: Median (IQR) time to ROSC was 172(103–418)s, 157(100–413)s, 122(93–289)s, and 276(117–480)s for 0.2, 0.4, 0.8IU/kg vasopressin, and 0.02 mg/kg epinephrine groups, respectively (p = 0.59). The number of piglets that achieved ROSC was 6(75%), 6(75%), 7(88%), and 5(63%) for 0.2, 0.4, 0.8IU/kg vasopressin, and 0.02 mg/kg epinephrine, respectively (p = 0.94). The epinephrine group had a 60% (3/5) rate of post-ROSC survival compared to 83% (5/6), 83% (5/6), and 57% (4/7) in the 0.2, 0.4, and 0.8IU/kg vasopressin groups, respectively (p = 0.61).

CONCLUSION: Time to and incidence of ROSC were not different between all vasopressin dosages and epinephrine. However, nonsignificantly lower time to ROSC and higher post-ROSC survival in vasopressin groups warrant further investigation.

IMPACT:

- Time to and incidence of ROSC were not statistically different between all vasopressin dosages and epinephrine.

- Non-significantly lower time to ROSC and higher post-ROSC survival in vasopressin-treated piglets.

- Overall poorer hemodynamic recovery following ROSC in epinephrine piglets compared to vasopressin groups.

- Human neonatal clinical trials examining the efficacy of vasopressin during asphyxial cardiac arrest will begin recruitment soon.

https://www.nature.com/articles/s41390-023-02858-x.epdf