Evaluation of Timing and Route of Epinephrine in a Neonatal Model of Asphyxial Arrest
Evaluation of Timing and Route of Epinephrine in a Neonatal Model of Asphyxial Arrest
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DOI：
10.1161/jaha.116.004402
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发表时间：
2017-02-01
影响因子：
5.4
通讯作者：
Lakshminrusimha, Satyan
中科院分区：
文献类型：
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作者：
Vali, Payam;Chandrasekharan, Praveen;Lakshminrusimha, Satyan
背景-通过低位脐静脉导管（UVC）或气管内导管（ETT）给予肾上腺素适用于出生时对正压通气和胸外按压无反应的新生儿。ETT肾上腺素通过充满液体的肺或UVC肾上腺素在存在胎儿分流的情况下的药代动力学尚不清楚。我们假设，通过ETT或低UVC给予肾上腺素导致血浆肾上腺素浓度和自主循环（ROSC）恢复率与右心房（RA）肾上腺素相似。方法和结果-将44只羔羊随机分为以下组：RA肾上腺素（0.03 mg/kg）、低UVC肾上腺素（0.03 mg/kg）、压迫后ETT肾上腺素（0.1 mg/kg）和压迫前ETT肾上腺素（0.1 mg/kg）。通过脐带阻塞诱导心搏停止。心搏停止5分钟后开始复苏。44只羔羊中有38只实现了ROSC（RA、UVC和ETT组分别为10/11、9/11和12/22;随后的RA肾上腺素导致ETT组的总ROSC为19/22）。ETT组（包括接受RA肾上腺素的患者）达到ROSC的中位时间（四分位距）显著长于静脉组（4.5 [2.9-7.4] vs 2 [1.9-3]分钟; P=0.02）。RA和低UVC肾上腺素给药1分钟时达到的血浆肾上腺素峰值浓度（470 +/- 250 vs 450 +/-190 ng/mL）与5分钟时ETT值130 +/-60 ng/mL相当; P=0.03。在ROSC中单独使用ETT肾上腺素后，肾上腺素浓度峰值延迟（652 +/-240 ng/mL）。结论-出生时ETT肾上腺素的吸收较低且延迟。RA和低UVC肾上腺素迅速达到高血浆浓度，导致ROSC。
Background-Epinephrine administered by low umbilical venous catheter (UVC) or endotracheal tube (ETT) is indicated in neonates who fail to respond to positive pressure ventilation and chest compressions at birth. Pharmacokinetics of ETT epinephrine via fluid-filled lungs or UVC epinephrine in the presence of fetal shunts is unknown. We hypothesized that epinephrine administered by ETT or low UVC results in plasma epinephrine concentrations and rates of return of spontaneous circulation (ROSC) similar to right atrial (RA) epinephrine.Methods and Results-Forty-four lambs were randomized into the following groups: RA epinephrine (0.03mg/kg), low UVC epinephrine (0.03mg/kg), postcompression ETT epinephrine (0.1mg/kg), and precompression ETT epinephrine (0.1mg/kg). Asystole was induced by umbilical cord occlusion. Resuscitation was initiated following 5minutes of asystole. Thirty-eight of 44 lambs achieved ROSC (10/11, 9/11, and 12/22 in the RA, UVC, and ETT groups, respectively; subsequent RA epinephrine resulted in a total ROSC of 19/22 in the ETT groups). Median time (interquartile range) to achieve ROSC was significantly longer in the ETT group (including those that received RA epinephrine) compared to the intravenous group (4.5 [2.9-7.4] versus 2 [1.9-3] minutes; P=0.02). RA and low UVC epinephrine administration achieved comparable peak plasma epinephrine concentrations (470 +/- 250 versus 450 +/- 190ng/mL) by 1minute compared to ETT values of 130 +/- 60ng/mL at 5minutes; P=0.03. Following ROSC with ETT epinephrine alone, there was a delayed peak epinephrine concentration (652 +/- 240ng/mL).Conclusions-The absorption of ETT epinephrine is low and delayed at birth. RA and low UVC epinephrine rapidly achieve high plasma concentrations resulting in ROSC.