Abstract
Background
Asphyxia is the most common reason for newborns to fail to make a successful fetal-to-neonatal transition. There is currently a lack of data evaluating hemodynamic effects of epinephrine during neonatal cardiopulmonary resuscitation.
Methods
Twenty-four newborn piglets were exposed to asphyxia. Thereafter, positive pressure ventilation was commenced for 30 s, followed by chest compressions (CC). Piglets were randomized into three experimental groups: 3:1 compression:ventilation ratio; CC during sustained inflation (SI) at a rate of 90 CC per minute, or CC during SI at a rate of 120 CC per minute. Epinephrine (0.01 mg/kg per dose) was administered to a maximum of four doses. Hemodynamic parameters were measured throughout the experiment.
Results
Animals were divided into survivors and nonsurvivors. End-diastolic and developed pressures declined after epinephrine administration in the survivor group. dp/dt min was significantly higher in the survivor group whereas dp/dt max showed no significant differences. Epinephrine had no effect on either heart rate or cardiac output in both groups. Ejection fraction increased after epinephrine with no significant difference between groups.
Conclusion
Epinephrine did not affect survival rates or return of spontaneous circulation in our postnatal porcine model of neonatal asphyxia.
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AUTHOR CONTRIBUTIONS
Conception and design: G.M.S. and P.Y.C. Collection and assembly of data: G.M.S., E.S.L., T.F.L., M.L., M.O.R., P.Y.C., and M.W. Analysis and interpretation of the data: G.M.S., E.S.L., T.F.L., M.L., M.O.R., P.Y.C., M.W., and M.O. Drafting of the article: G.M.S., E.S.L., T.F.L., M.L., M.O.R., P.Y.C., M.W., and M.O. Critical revision of the article for important intellectual content: G.M.S., E.S.L., T.F.L., M.L., M.O.R., P.Y.C., M.W., and M.O. Final approval of the article: G.M.S., E.S.L., T.F.L., M.L., M.O.R., P.Y.C., M.W., and M.O.
STATEMENT OF FINANCIAL SUPPORT:
We thank the public for donating money to our funding agencies: E.S.L. was supported by Alberta Innovates–Health Solutions Summer-Studentship. G.M.S. is a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation, a National New Investigator of the Heart and Stroke Foundation Canada, and an Alberta New Investigator of the Heart and Stroke Foundation Alberta. We acknowledge the Neonatal Resuscitation Program Canada Grant Program within the Canadian Society of Pediatrics for supporting the study.
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Wagner, M., Cheung, PY., Li, E. et al. Effects of epinephrine on hemodynamic changes during cardiopulmonary resuscitation in a neonatal piglet model. Pediatr Res 83, 897–903 (2018). https://doi.org/10.1038/pr.2017.316
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DOI: https://doi.org/10.1038/pr.2017.316
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