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Comparison of intravenous and intraosseous administration of vasopressin and epinephrine during cardiopulmonary resuscitation of asphyxiated neonatal piglets

Pediatric Research (2025)Cite this article

Abstract

Background

Epinephrine is currently the only vasopressor recommended during neonatal cardiopulmonary resuscitation (CPR). Previous neonatal animal studies suggested intravenous (IV) vasopressin as a potential alternative; however, no neonatal study has compared the efficacy of intraosseous (IO) with IV vasopressin to epinephrine administration during CPR.

Design/Methods

Newborn piglets (n = 8/group) were anesthetized, intubated, surgically instrumented, and exposed to normocapnic hypoxia followed by asphyxia and asystole. Piglets were resuscitated following randomization to 0.4IU/kg IV or IO vasopressin, or 0.02 mg/kg IV or IO epinephrine.

Results

There were no differences in median (IQR) time to return of spontaneous circulation (ROSC) between IV and IO vasopressin (254 (220-473) vs. 215 (200-240)sec, respectively, p = 0.143), IV and IO epinephrine (272 (265-278) vs. 233 (203-266)sec, respectively, p = 0.286), or all four groups (p = 0.312). The number of piglets that achieved ROSC was similar with IV and IO vasopressin (5 (63%) vs. 3 (38%), respectively, p = 0.619), IV and IO epinephrine (2 (25%) vs. 6 (75%), respectively, p = 0.132), and between all groups (p = 0.233).

Conclusions

Vasopressin given either via IO or IV had no difference in time to or rates of ROSC compared to IV and IO epinephrine.

Impact

  • This is the first neonatal animal study to compare intraosseous (IO) and intravenous (IV) vasopressin during cardiac arrest.

  • Time to and rates of return of spontaneous circulation (ROSC) were similar between IO and IV vasopressin.

  • Time to and incidence of ROSC were not statistically different between vasopressin and epinephrine, regardless of IV or IO administration.

  • Hemodynamic changes during cardiopulmonary resuscitation are similar between vasopressin and epinephrine groups.

  • Plasma vasopressor concentrations were similar between IO and IV routes

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Fig. 1: Study flow chart.
Fig. 2: Hemodynamic changes from baseline during resuscitation following asystolic cardiac arrest in piglets that achieved ROSC.
Fig. 3: Hemodynamic changes throughout the experiment.
Fig. 4: Plasma vasopressin concentrations.
Fig. 5: Plasma epinephrine concentrations.

Data availability

All data generated or analyzed during this study are included in this published article.

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Funding

We would like to thank the public for donating money to our funding agencies: M.R. is a recipient of the Motyl Graduate Studentships in Cardiac Sciences, Women and Children’s Health Research Institute Graduate Studentship, and Alberta Excellence Graduate Scholarship. This study was supported by a Heart and Stroke Foundation of Canada Grant in Aid (G-22-0031980).

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Authors and Affiliations

  1. Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada

    Marwa Ramsie, Po-Yin Cheung, Raza Hyderi, Tze-Fun Lee, Megan O’Reilly & Georg M. Schmölzer

  2. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    Marwa Ramsie, Po-Yin Cheung, Tze-Fun Lee, Megan O’Reilly & Georg M. Schmölzer

Authors
  1. Marwa Ramsie
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  2. Po-Yin Cheung
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  3. Raza Hyderi
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  4. Tze-Fun Lee
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  5. Megan O’Reilly
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  6. Georg M. Schmölzer
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Contributions

Conception and design: G.M.S., P.Y.C., M.R., M.O.R., and T.F.L. Collection and assembly of data: G.M.S., P.Y.C., M.R., M.O.R., T.F.L., and R.H. Analysis and interpretation of the data: G.M.S., P.Y.C., M.R., M.O.R., T.F.L., and RH. Drafting of the 1st draft: M.R. Drafting of the article: G.M.S., P.Y.C., M.R., M.O.R., T.F.L., and R.H. Critical revision of the article for important intellectual content: G.M.S., P.Y.C., M.R., M.O.R., T.F.L., and R.H. Final approval of the article: G.M.S., P.Y.C., M.R., M.O.R., T.F.L., and R.H.

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Correspondence to Georg M. Schmölzer.

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Ramsie, M., Cheung, PY., Hyderi, R. et al. Comparison of intravenous and intraosseous administration of vasopressin and epinephrine during cardiopulmonary resuscitation of asphyxiated neonatal piglets. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04423-0

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  • DOI: https://doi.org/10.1038/s41390-025-04423-0

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