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CRITICAL CARE AND TRAUMA

Survival with Full Neurologic Recovery After Prolonged Cardiopulmonary Resuscitation with a Combination of Vasopressin and Epinephrine in Pigs

Karl H. Stadlbauer, MD^*, Horst G. Wagner-Berger, MD^*, Volker Wenzel, MD^*, Wolfgang G. Voelckel, MD^*, Anette C. Krismer, MD^*, Günter Klima, MD, Klaus Rheinberger, MSc^*, Sebastian Pechlaner, BS^*, Viktoria D. Mayr, MD^*, and Karl H. Lindner, MD^*

Departments of *Anesthesiology and Critical Care Medicine and Histology, Leopold-Franzens-University, Innsbruck, Austria

Address correspondence and reprint requests to Karl-Heinz Stadlbauer, MD, Leopold-Franzens-University, Department of Anesthesiology and Critical Care Medicine, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to karl-heinz.stadlbauer{at}uibk.ac.at

We sought to determine the effects of a combination of vasopressin and epinephrine on neurologic recovery in comparison with epinephrine alone and saline placebo alone in an established porcine model of prolonged cardiopulmonary resuscitation (CPR). After 4 min of cardiac arrest, followed by 3 min of basic life support CPR, 17 animals were randomly assigned to receive, every 5 min, either a combination of vasopressin and epinephrine (vasopressin [IU/kg]/epinephrine [µg/kg]: 0.4/45, 0.4/45, and 0.8/45; n = 6), epinephrine alone (45, 45, and 200 µg/kg; n = 6), or saline placebo alone (n = 5). After 22 min of cardiac arrest, including 18 min of CPR, defibrillation was attempted to achieve the return of spontaneous circulation. Aortic diastolic pressure was significantly (P < 0.01) increased 90 s after each of 3 vasopressin/epinephrine injections versus epinephrine alone versus saline placebo alone (mean ± SEM: 69 ± 3 mm Hg versus 45 ± 3 mm Hg versus 29 ± 2 mm Hg, 63 ± 4 mm Hg versus 27 ± 3 mm Hg versus 23 ± 1 mm Hg, and 52 ± 4 mm Hg versus 21 ± 3 mm Hg versus 16 ± 3 mm Hg, respectively). Spontaneous circulation was restored in six of six vasopressin/epinephrine pigs, whereas six of six epinephrine and five of five saline placebo pigs died (P < 0.01). Neurologic evaluation 24 h after successful resuscitation revealed only an unsteady gait and was normal 5 days after the experiment in all vasopressin/epinephrine-treated animals. In conclusion, in this porcine model of prolonged CPR, repeated vasopressin/epinephrine administration, but not epinephrine or saline placebo alone, ensured long-term survival with full neurologic recovery.

IMPLICATIONS: We present a study to evaluate the effects of a combination of vasopressin and epinephrine during prolonged cardiopulmonary resuscitation on neurological outcome in pigs. We found that all pigs treated with a combination of vasopressin and epinephrine could be resuscitated and had full neurologic recovery observed over an entire period of 5 days.

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