Effects of epinephrine on hemodynamic changes during cardiopulmonary resuscitation in a neonatal piglet model

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 cardi- opulmonary resuscitation. METHODS: Twenty-four newborn piglets were exposed to asphyxia. Thereafter, positive pressure ventilation was com- menced for 30 s, followed by chest compressions (CC). Piglets were randomized into three expenmental 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 measuied throughout the experiment. RESULTS: Animals were divided into survivors and non- survivors. End-diastolic and developed pressures declined aftei epinephrine administiation 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 sig- nificant difference between groups. CONCLUSION: Epinephrine did not affect suivival rates or return of spontaneous circulation in our postnatal porcine model of neonatal asphyxia.