• Rafael González, Javier Urbano, Marta Botrán, Jorge López, Maria J Solana, Ana García, Sarah Fernández, and Jesús López-Herce.
• 1Paediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 2Instituto de Investigación del Hospital General Universitario Gregorio Marañón, Madrid, Spain. 3Spanish Health Institute Carlos III. Maternal, Child Health and Development Network, Madrid, Spain.
• Pediatr Crit Care Me. 2014 Jul 1;15(6):e280-7.

ObjectiveTo analyze if treatment with adrenaline (epinephrine) plus terlipressin plus corticoids achieves higher return of spontaneous circulation than adrenaline in an experimental infant animal model of asphyxial cardiac arrest.DesignProspective randomized animal study.SettingExperimental department in a University Hospital.SubjectsForty-nine piglets were studied.InterventionsCardiac arrest was induced by at least 10 minutes of removal of mechanical ventilation and was followed by manual external chest compressions and mechanical ventilation. After 3 minutes of resuscitation, piglets that did not achieve return of spontaneous circulation were randomized to two groups: adrenaline 0.02 mg kg every 3 minutes (20 animals) and adrenaline 0.02 mg kg every 3 minutes plus terlipressin 20 μg kg every 6 minutes plus hydrocortisone 30 mg kg one dose (22 animals). Resuscitation was discontinued when return of spontaneous circulation was achieved or after 24 minutes.Measurement And Main ResultsReturn of spontaneous circulation was achieved in 14 piglets (28.5%), 14.2% with only cardiac massage and ventilation. Return of spontaneous circulation was achieved in 25% of piglets treated with adrenaline and in 9.1% of those treated with adrenaline plus terlipressin plus hydrocortisone (p = 0.167). Return of spontaneous circulation was achieved in 45.4% of animals with pulseless electric activity, 20% with asystole, and 0% with ventricular fibrillation (p = 0.037). Shorter duration of cardiac arrest, higher mean blood pressure and EtCO2 and lower PaCO2 before resuscitation, and higher mean blood pressure during resuscitation were associated with higher return of spontaneous circulation.ConclusionsTreatment with adrenaline plus terlipressin plus corticoids does not achieve higher return of spontaneous circulation than that with adrenaline in an infant animal model of asphyxial cardiac arrest.

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