(Circulation. 1995;91:215-221.)
© 1995 American Heart Association, Inc.
Articles |
Vasopressin Improves Vital Organ Blood Flow During Closed-Chest Cardiopulmonary Resuscitation in Pigs
From the Department of Anesthesiology and Critical Care Medicine, University of Ulm, Germany (K.H.L., A.W.P., E.G.P., I.M.L., H.U.S., M.G.), and the Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis (K.G.L.).
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 · min-1 · l00 g-1 (mean±SEM) in the epinephrine group; 18±2, 50±6, and 29±3 mL · min-1 · 100 g-1 in the low-dose vasopressin group; 17±3, 52±8, and 52±6 mL · min-1 · 100 g-1 in the medium-dose vasopressin group; and 18±2, 95±9, and 57±6 mL · min-1 · 100 g-1 in the high-dose vasopressin group (P<.001 at 90 seconds and 5 minutes between epinephrine and high-dose vasopressin, and P<.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<.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 mm Hg in the epinephrine group; 13±1, 25±2, and 20±1 mm Hg in the low-dose vasopressin group; 13±2, 25±2, and 21±2 mm Hg in the medium-dose vasopressin group; and 13±2, 35±3, and 24±2 mm Hg in the high-dose vasopressin group (P<.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<.05 at 90 seconds and P<.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.
Key Words: fibrillation • microspheres • regional blood flow • acid-base imbalance
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