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(Stroke. 1998;29:1462-1468.)
© 1998 American Heart Association, Inc.

Original Contributions

Vasopressin Combined With Epinephrine Decreases Cerebral Perfusion Compared With Vasopressin Alone During Cardiopulmonary Resuscitation in Pigs

Volker Wenzel, MD; Karl H. Lindner, MD; Sven Augenstein; Andreas W. Prengel, MD; Hans U. Strohmenger, MD

From the Department of Anesthesiology, University of Ulm, Ulm, Germany (V.W., K.H.L., S.A., A.W.P., H.U.S.); the Department of Anaesthesia and Intensive Care Medicine, Leopold Franzens University of Innsbruck, Austria (V.W., K.H.L., S.A., H.U.S.); and the Department of Anesthesiology, Knappschaft Hospital, Ruhr University, Bochum, Germany (A.W.P.).

Correspondence to Dr Volker Wenzel, The Leopold Franzens University of Innsbruck, Department of Anaesthesia and Intensive Care Medicine, Anichstrasse 35, 6020 Innsbruck, Austria. E-mail Volker.Wenzel{at}uibk.ac.at

Background and Purpose—It is unknown whether a combination of vasopressin and epinephrine may be superior to vasopressin alone by targeting both nonadrenergic and adrenergic receptors.

Methods—After 15 minutes of cardiac arrest (13 minutes of ventricular fibrillation and 2 minutes of pulseless electrical activity) and 3 minutes of chest compressions, 16 animals were randomly treated with either 0.8 U/kg vasopressin (n=8) or 0.8 U/kg vasopressin combined with 200 µg/kg epinephrine (n=8).

Results—Comparison of vasopressin with vasopressin and epinephrine at 90 seconds and 5 minutes after drug administration resulted in comparable mean (±SEM) coronary perfusion pressure (54±3 versus 57±5 and 36±4 versus 35±4 mm Hg, respectively), cerebral perfusion pressure (59±6 versus 65±8 and 40±6 versus 39±6 mm Hg, respectively), and median (25th to 75th percentiles) left ventricular myocardial blood flow [116 (81 to 143) versus 108 (97 to 125) and 44 (35 to 81) versus 62 (42 to 74) mL · min^-1 · 100 g^-1, respectively], but significantly increased (P<0.05) total cerebral blood flow [81 (77 to 95) versus 39 (34 to 58) and 50 (43 to 52) versus 28 (16 to 35) mL · min^-1 · 100 g^-1, respectively]. Return of spontaneous circulation rates in both groups were comparable (vasopressin, 7 of 8; vasopressin and epinephrine, 6 of 8).

Conclusions—Comparison of vasopressin with vasopressin and epinephrine resulted in comparable left ventricular myocardial blood flow but significantly increased cerebral perfusion.

Editorial Comment

Raymond C. Koehler, PhD, Guest Editor

Department of Anesthesiology/Critical Care Medicine The Johns Hopkins University Baltimore, Maryland

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