Epinephrine vs placebo in neonatal resuscitation: ROSC and brain MRS/MRI in term piglets.

Autor: Andersen HB; Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark. hannah.brogaard@clin.au.dk., Andersen M; Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark., Andelius TCK; Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark., Pedersen MV; Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark., Løfgren B; Research Center for Emergency, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Pedersen M; Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark., Ringgaard S; The MR Research Centre, Aarhus University Hospital, Aarhus, Denmark., Kyng KJ; Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark., Henriksen TB; Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Pediatric research [Pediatr Res] 2023 Feb; Vol. 93 (3), pp. 511-519. Date of Electronic Publication: 2022 Jun 09.
DOI: 10.1038/s41390-022-02126-4
Abstrakt: Background: We aimed to investigate the effect of epinephrine vs placebo on return of spontaneous circulation (ROSC) and brain magnetic resonance spectroscopy and imaging (MRS/MRI) in newborn piglets with hypoxic cardiac arrest (CA).
Methods: Twenty-five piglets underwent hypoxia induced by endotracheal tube clamping until CA. The animals were randomized to CPR + intravenous epinephrine or CPR + placebo (normal saline). The primary outcome was ROSC, and secondary outcomes included time-to-ROSC, brain MRS/MRI, and composite endpoint of death or severe brain MRS/MRI abnormality.
Results: ROSC was more frequent in animals treated with epinephrine than placebo; 10/13 vs 4/12, RR = 2.31 (95% CI: 1.09-5.77). We found no difference in time-to-ROSC (120 (113-211) vs 153 (116-503) seconds, p = 0.7) or 6-h survival (7/13 vs 3/12, p = 0.2). Among survivors, there was no difference between groups in brain MRS/MRI. We found no difference in the composite endpoint of death or severe brain MRS/MRI abnormality; RR = 0.7 (95% CI: 0.37-1.19).
Conclusions: Resuscitation with epinephrine compared to placebo improved ROSC frequency after hypoxic CA in newborn piglets. We found no difference in time-to-ROSC or the composite endpoint of death or severe brain MRS/MRI abnormality.
Impact: In a newborn piglet model of hypoxic cardiac arrest, resuscitation with epinephrine compared to placebo improved the rate of return of spontaneous circulation and more than doubled the 6-h survival. Brain MRS/MRI biomarkers were used to evaluate the effect of epinephrine vs placebo. We found no difference between groups in the composite endpoint of death or severe brain MRS/MRI abnormality. This study adds to the limited evidence regarding the effect and safety of epinephrine; the lack of high-quality evidence from randomized clinical trials was highlighted in the latest ILCOR 2020 guidelines, and newborn animal studies were specifically requested.
(© 2022. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)
Databáze: MEDLINE
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