Masked Randomized Trial of Epinephrine versus Vasopressin in an Ovine Model of Perinatal Cardiac Arrest.
Masked Randomized Trial of Epinephrine versus Vasopressin in an Ovine Model of Perinatal Cardiac Arrest.
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DOI：
10.3390/children10020349
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发表时间：
2023-02-10
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
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背景资料：目前的新生儿复苏指南建议使用肾上腺素治疗对通气和胸外按压无反应的心动过缓/心跳骤停。血管加压素是一种全身性血管收缩剂，在出生后发生心脏骤停的仔猪中比肾上腺素更有效。目前还没有研究比较血管加压素和肾上腺素在新生动物模型与脐带阻断诱导的心脏骤停。目的：比较肾上腺素和加压素对围产期心脏骤停的发生率和自主循环恢复时间（ROSC）、血流动力学、血浆药物水平和血管反应性的影响。设计/方法：27个足月胎羊心脏骤停诱导脐带闭塞仪器和复苏后，随机肾上腺素或加压素通过低脐静脉导管。结果：8只羔羊在给药前达到了ROSC。肾上腺素在8 ± 2分钟内使7/10只羔羊达到ROSC。加压素在13 ± 6分钟内使3/9只羔羊达到ROSC。首次给药后，无反应者的血浆加压素水平远低于反应者。加压素在体内引起肺血流量增加和体外冠状血管收缩。结论：在围产期心脏骤停模型中，与肾上腺素相比，血管加压素导致ROSC发生率较低且时间较长，这支持了目前在新生儿复苏中仅使用肾上腺素的建议。
Background: Current neonatal resuscitation guidelines recommend the use of epinephrine for bradycardia/arrest not responding to ventilation and chest compressions. Vasopressin is a systemic vasoconstrictor and is more effective than epinephrine in postnatal piglets with cardiac arrest. There are no studies comparing vasopressin with epinephrine in newly born animal models with cardiac arrest induced by umbilical cord occlusion. Objective: To compare the effect of epinephrine and vasopressin on the incidence and time to return of spontaneous circulation (ROSC), hemodynamics, plasma drug levels, and vasoreactivity in perinatal cardiac arrest. Design/Methods: Twenty-seven term fetal lambs in cardiac arrest induced by cord occlusion were instrumented and resuscitated following randomization to epinephrine or vasopressin through a low umbilical venous catheter. Results: Eight lambs achieved ROSC prior to medication. Epinephrine achieved ROSC in 7/10 lambs by 8 ± 2 min. Vasopressin achieved ROSC in 3/9 lambs by 13 ± 6 min. Plasma vasopressin levels in nonresponders were much lower than responders after the first dose. Vasopressin caused in vivo increased pulmonary blood flow and in vitro coronary vasoconstriction. Conclusions: Vasopressin resulted in lower incidence and longer time to ROSC compared to epinephrine in a perinatal model of cardiac arrest supporting the current recommendations for exclusive use of epinephrine in neonatal resuscitation.
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影响因子：
8.8
作者：
REDDING, JS;PEARSON, JW
通讯作者：
PEARSON, JW
DOI：
10.1016/s0140-6736(17)32152-9
发表时间：
2017-09-16
期刊：
Lancet (London, England)
影响因子：
--
作者：
GBD 2016 Causes of Death Collaborators
通讯作者：
GBD 2016 Causes of Death Collaborators
DOI：
10.1136/archdischild-2020-321034
发表时间：
2021-11
期刊：
Archives of disease in childhood. Fetal and neonatal edition
影响因子：
--
作者：
Sankaran D;Chandrasekharan PK;Gugino SF;Koenigsknecht C;Helman J;Nair J;Mathew B;Rawat M;Vali P;Nielsen L;Tancredi DJ;Lakshminrusimha S
通讯作者：
Lakshminrusimha S
影响因子：
3.6
作者：
Enomoto, Masahiro;Pan, Jingyi;Shifrin, Yulia;Belik, Jaques
通讯作者：
Belik, Jaques
影响因子：
3.7
作者：
Vali P;Chandrasekharan P;Rawat M;Gugino S;Koenigsknecht C;Helman J;Mathew B;Berkelhamer S;Nair J;Wyckoff M;Lakshminrusimha S
通讯作者：
Lakshminrusimha S