297 - Intraosseous versus intravenous vasopressor administration in a neonatal piglet model of asystolic cardiopulmonary resuscitation

Publication Number: 297.5204

Marwa Ramsie, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Po-Yin Cheung, University of Alberta, Edmonton, AB, Canada; Megan O'Reilly, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Tze-fun Lee, University of Alberta, Edmonton, AB, Canada; Georg Schmölzer, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada

Background: Current neonatal resuscitation guidelines recommend epinephrine preferably be given via intravenous (IV) or intraosseous (IO) routes during cardiac arrest. Vasopressin might be an alternative during asphyxial cardiac arrest; however, whether it remains effective when administered via IO is unclear.

Objective: We aimed to compare IO with IV vasopressin or epinephrine on incidence and time to return of spontaneous circulation (ROSC) in asphyxiated newborn piglets.

Design/Methods: Thirty-two newborn piglets (n=8/group) were anesthetized, intubated, instrumented, and exposed to 45 minutes of normocapnic hypoxia, followed by asphyxiation until asystole. Piglets were randomized to 0.4IU/kg IV or IO vasopressin, or 0.02mg/kg IV or IO epinephrine. Vasopressin or epinephrine was administered via IV or IO 1 minute after the start of chest compressions (CCs) and administered every 3 minutes as needed if no return of spontaneous circulation (ROSC) was observed, to a maximum of three doses.

Results: Rates of ROSC were not different between IV or IO vasopressin, 5/8(63%) vs 3/8(38%), respectively (p=0.619), or between IV or IO epinephrine, 2/8(25%) vs 6/8(75%), respectively (p=0.132). Rates of ROSC were similar between all four groups (p=0.233). Median (IQR) time to ROSC was 254 (220-473)sec and 215 (200-240)sec for IV and IO vasopressin, respectively (p=0.143), and 272 (265-278)sec and 233 (203-266)sec for IV and IO epinephrine, respectively (p=0.286). Time to ROSC was similar amongst all groups (p=0.312).

Conclusion(s): In a neonatal piglet model of asphyxial cardiac arrest, administration of IO vasopressin or epinephrine resulted in similar resuscitative outcomes to IV vasopressin or epinephrine. Our findings suggest that IO vasopressor administration during neonatal resuscitation is effective, and that IO vasopressin is a feasible alternative to IV vasopressin.