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CARDIOVASCULAR ANESTHESIA

The Effects of Repeated Doses of Vasopressin or Epinephrine on Ventricular Fibrillation in a Porcine Model of Prolonged Cardiopulmonary Resuscitation

Ulrich Achleitner, MSc^*, Volker Wenzel, MD^*, Hans-Ulrich Strohmenger, MD^*, Anette C. Krismer, MD^*, Keith G. Lurie, MD, Karl H. Lindner, MD^*, and Anton Amann, PhD^*

*Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria; and the Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota

Address correspondence and reprint requests to Anton Amann, PhD, The Leopold-Franzens University of Innsbruck, Department of Anesthesiology and Critical Care Medicine, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to anton.amann{at}uibk.ac.at

This study evaluated ventricular fibrillation mean frequency and amplitude to predict defibrillation success in a porcine cardiopulmonary resuscitation (CPR) model using repeated administration of vasopressin or epinephrine. After 4 min of cardiac arrest and 3 min of CPR, 10 pigs were randomly assigned to receive either vasopressin (early vasopressin: 0.4, 0.4, and 0.8 units/kg, respectively, n = 5) or epinephrine (early epinephrine: 45, 45, and 200 µg/kg, respectively, n = 5). Another 11 animals were randomly allocated after 4 min of cardiac arrest and 8 min of CPR to receive every 5 min either vasopressin (late vasopressin: 0.4 and 0.8 units/kg, respectively, n = 5) or epinephrine (late epinephrine: 45 and 200 µg/kg, n = 6). Ventricular fibrillation mean frequency and amplitude on defibrillation were significantly higher in the vasopressin groups than in the epinephrine groups, respectively. In vasopressin versus epinephrine animals, mean frequency immediately before defibrillation was 9.6 ± 1.5 Hz vs 7.0 ± 0.7 Hz (P < 0.001), mean amplitude was 0.65 ± 0.26 mV vs 0.21 ± 0.14 mV (P < 0.001, and coronary perfusion pressure was 27 ± 9 mm Hg vs 8 ± 4 mm Hg (P < 0.00001), respectively. In contrast to no epinephrine animals, all vasopressin animals were successfully defibrillated and survived 1 h (P < 0.05). Mean fibrillation frequency and amplitude predicted successful defibrillation and may serve as noninvasive markers to monitor continuing CPR efforts. Furthermore, vasopressin was superior to epinephrine in maintaining these variables above a threshold necessary for successful defibrillation.

Implications: Mean frequency and amplitude of ventricular fibrillation predicted successful defibrillation in pigs. Vasopressin was superior to epinephrine in maintaining these variables above a success defibrillation threshold.

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