The Efficacy of Terlipressin versus Adrenaline in Swine Cardiopulmonary Resuscitation

Ovalle CCIS, Moreira MM, Martins LC, Araujo S - The Efficacy of Terlipressin versus Adrenaline in Swine Cardiopulmonary Resuscitation. Background and objectives: The objective of the present study was to evaluate the efficacy of terlipressin (TP) vs. adrenaline (ADR) in increasing coronary perfusion pressure (CPP) and return of spontaneous circulation (ROSC) in swine CPR. Methods: Under anesthesia with ketamine/thiopental, ventricular fibrillation was induced in 44 female immature pigs, remaining unassisted for 10 minutes, followed by 2 minutes of manual CPR (100 compression/10 ventilations/min with air). Animals were, then, divided into four groups: 1) ADR (45 mu g.kg(-1)); 2) saline-placebo (10 mL); 3) TP 20 mu g.kg(-1)); and TP (20 mu g.kg(-1)) + ADR (45 mu g.kg(-1)). Defibrillation was performed after 2 minutes, observing surviving animals for a 30-minute period. Electrocardiogram, systemic BP, DBP, and PetCO(2) were monitored continuously. Results: Terlipressin did not differ from placebo regarding the effects on CPP, with low rates of ROSC in both groups (1/11 vs. 2/11; p = NS). Adrenaline increased CPP from 13 +/- 12 to 54 +/- 15 mmHg (p < 0.0001), similar effect to TP + ADR (from 21 +/- 10 to 45 +/- 13 mmHg; p < 0.0001), with high rates of ROSC/survivors in both groups (10/11 vs. 9/11, respectively). Among survivors, greater MAP was observed in the TP + ADR group vs. ADR (105 +/- 19 mmHg vs. 76 +/- 21 mmHg; p = 0.0157) groups. Conclusions: Adrenaline and TP + ADR were effective on maintaining CPP/ROSC in this experimental model, but isolated TP did not differ from placebo. However, in surviving animals in the TP + ADR group, greater hemodynamic stability was observed after ROSC, suggesting that TP can be a useful medication in the management of post-CPR hypotension.