Repeated administration of vasopressin but not epinephrine maintains coronary perfusion pressure after early and late administration during prolonged cardiopulmonary resuscitation in pigs

Abstract

Background - It is unknown whether repeated dosages of vasopressin or epinephrine given early or late during basic life support cardiopulmonary resuscitation (CPR) may be able to increase coronary perfusion pressure above a threshold between 20 and 30 mm Hg that renders defibrillation successful. Methods and Results - After 4 minutes of cardiac arrest, followed by 3 minutes of basic life support CPR, 12 animals were randomly assigned to receive, every 5 minutes, either vasopressin (early vasopressin: 0.4, 0.4, and 0.8 U/kg, respectively; n=6) or epinephrine (early epinephrine: 45, 45, and 200 μg/kg, respectively; n=6). Another 12 animals were randomly allocated after 4 minutes of cardiac arrest, followed by 8 minutes of basic life support CPR, to receive, every 5 minutes, either vasopressin (late vasopressin: 0.4 and 0.8 U/kg, respectively; n=6), or epinephrine (late epinephrine: 45 and 200 μg/kg, respectively; n=6). Defibrillation was attempted after 22 minutes of cardiac arrest. Mean±SEM coronary perfusion pressure was significantly higher 90 seconds after early vasopressin compared with early epinephrine (50±4 versus 34±3 mm Hg, P<0.02; 42±5 versus 15±3 mm Hg, P<0.0008; and 37±5 versus 11±3 mm Hg, P<0.002, respectively). Mean±SEM coronary perfusion pressure was significantly higher 90 seconds after late vasopressin compared with late epinephrine (40±3 versus 22±4 mm Hg, P<0.004, and 3.2±4 versus 15±4 mm Hg, P<0.01, respectively). All vasopressin animals survived 60 minutes, whereas no epinephrine pig had return of spontaneous circulation (P<0.05). Conclusions - Repeated administration of vasopressin but only the first epinephrine dose given early and late during basic life support CPR maintained coronary perfusion pressure above the threshold that is needed for successful defibrillation.