Comparison of intravenous and intraosseous administration of vasopressin and epinephrine during cardiopulmonary resuscitation of asphyxiated neonatal piglets.

Abstract

Epinephrine is currently the only vasopressor recommended during neonatal cardiopulmonary resuscitation (CPR). Previous neonatal animal studies suggested intravenous (IV) vasopressin as a potential alternative; however, no neonatal study has compared the efficacy of intraosseous (IO) with IV vasopressin to epinephrine administration during CPR. Newborn piglets (n = 8/group) were anesthetized, intubated, surgically instrumented, and exposed to normocapnic hypoxia followed by asphyxia and asystole. Piglets were resuscitated following randomization to 0.4IU/kg IV or IO vasopressin, or 0.02 mg/kg IV or IO epinephrine. There were no differences in median (IQR) time to return of spontaneous circulation (ROSC) between IV and IO vasopressin (254 (220-473) vs. 215 (200-240)sec, respectively, p = 0.143), IV and IO epinephrine (272 (265-278) vs. 233 (203-266)sec, respectively, p = 0.286), or all four groups (p = 0.312). The number of piglets that achieved ROSC was similar with IV and IO vasopressin (5 (63%) vs. 3 (38%), respectively, p = 0.619), IV and IO epinephrine (2 (25%) vs. 6 (75%), respectively, p = 0.132), and between all groups (p = 0.233). Vasopressin given either via IO or IV had no difference in time to or rates of ROSC compared to IV and IO epinephrine. This is the first neonatal animal study to compare intraosseous (IO) and intravenous (IV) vasopressin during cardiac arrest. Time to and rates of return of spontaneous circulation (ROSC) were similar between IO and IV vasopressin. Time to and incidence of ROSC were not statistically different between vasopressin and epinephrine, regardless of IV or IO administration. Hemodynamic changes during cardiopulmonary resuscitation are similar between vasopressin and epinephrine groups. Plasma vasopressor concentrations were similar between IO and IV routes.