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Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest
The 7th edition of the Textbook of Neonatal Resuscitation recommends administration of epinephrine via an umbilical venous catheter (UVC) inserted 2–4 cm below the skin, followed by a 0.5-mL to 1-mL flush for severe bradycardia despite effective ventilation and chest compressions (CC). This volume o...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228479/ https://www.ncbi.nlm.nih.gov/pubmed/34205843 http://dx.doi.org/10.3390/children8060464 |
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author | Sankaran, Deepika Vali, Payam Chandrasekharan, Praveen Chen, Peggy Gugino, Sylvia F. Koenigsknecht, Carmon Helman, Justin Nair, Jayasree Mathew, Bobby Rawat, Munmun Nielsen, Lori Lesneski, Amy L. Hardie, Morgan E. Alhassen, Ziad Joudi, Houssam M. Giusto, Evan M. Zeinali, Lida Knych, Heather K. Weiner, Gary M. Lakshminrusimha, Satyan |
author_facet | Sankaran, Deepika Vali, Payam Chandrasekharan, Praveen Chen, Peggy Gugino, Sylvia F. Koenigsknecht, Carmon Helman, Justin Nair, Jayasree Mathew, Bobby Rawat, Munmun Nielsen, Lori Lesneski, Amy L. Hardie, Morgan E. Alhassen, Ziad Joudi, Houssam M. Giusto, Evan M. Zeinali, Lida Knych, Heather K. Weiner, Gary M. Lakshminrusimha, Satyan |
author_sort | Sankaran, Deepika |
collection | PubMed |
description | The 7th edition of the Textbook of Neonatal Resuscitation recommends administration of epinephrine via an umbilical venous catheter (UVC) inserted 2–4 cm below the skin, followed by a 0.5-mL to 1-mL flush for severe bradycardia despite effective ventilation and chest compressions (CC). This volume of flush may not be adequate to push epinephrine to the right atrium in the absence of intrinsic cardiac activity during CC. The objective of our study was to evaluate the effect of 1-mL and 2.5-mL flush volumes after UVC epinephrine administration on the incidence and time to achieve return of spontaneous circulation (ROSC) in a near-term ovine model of perinatal asphyxia induced cardiac arrest. After 5 min of asystole, lambs were resuscitated per Neonatal Resuscitation Program (NRP) guidelines. During resuscitation, lambs received epinephrine through a UVC followed by 1-mL or 2.5-mL normal saline flush. Hemodynamics and plasma epinephrine concentrations were monitored. Three out of seven (43%) and 12/15 (80%) lambs achieved ROSC after the first dose of epinephrine with 1-mL and 2.5-mL flush respectively (p = 0.08). Median time to ROSC and cumulative epinephrine dose required were not different. Plasma epinephrine concentrations at 1 min after epinephrine administration were not different. From our pilot study, higher flush volume after first dose of epinephrine may be of benefit during neonatal resuscitation. More translational and clinical trials are needed. |
format | Online Article Text |
id | pubmed-8228479 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-82284792021-06-26 Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest Sankaran, Deepika Vali, Payam Chandrasekharan, Praveen Chen, Peggy Gugino, Sylvia F. Koenigsknecht, Carmon Helman, Justin Nair, Jayasree Mathew, Bobby Rawat, Munmun Nielsen, Lori Lesneski, Amy L. Hardie, Morgan E. Alhassen, Ziad Joudi, Houssam M. Giusto, Evan M. Zeinali, Lida Knych, Heather K. Weiner, Gary M. Lakshminrusimha, Satyan Children (Basel) Article The 7th edition of the Textbook of Neonatal Resuscitation recommends administration of epinephrine via an umbilical venous catheter (UVC) inserted 2–4 cm below the skin, followed by a 0.5-mL to 1-mL flush for severe bradycardia despite effective ventilation and chest compressions (CC). This volume of flush may not be adequate to push epinephrine to the right atrium in the absence of intrinsic cardiac activity during CC. The objective of our study was to evaluate the effect of 1-mL and 2.5-mL flush volumes after UVC epinephrine administration on the incidence and time to achieve return of spontaneous circulation (ROSC) in a near-term ovine model of perinatal asphyxia induced cardiac arrest. After 5 min of asystole, lambs were resuscitated per Neonatal Resuscitation Program (NRP) guidelines. During resuscitation, lambs received epinephrine through a UVC followed by 1-mL or 2.5-mL normal saline flush. Hemodynamics and plasma epinephrine concentrations were monitored. Three out of seven (43%) and 12/15 (80%) lambs achieved ROSC after the first dose of epinephrine with 1-mL and 2.5-mL flush respectively (p = 0.08). Median time to ROSC and cumulative epinephrine dose required were not different. Plasma epinephrine concentrations at 1 min after epinephrine administration were not different. From our pilot study, higher flush volume after first dose of epinephrine may be of benefit during neonatal resuscitation. More translational and clinical trials are needed. MDPI 2021-06-01 /pmc/articles/PMC8228479/ /pubmed/34205843 http://dx.doi.org/10.3390/children8060464 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Sankaran, Deepika Vali, Payam Chandrasekharan, Praveen Chen, Peggy Gugino, Sylvia F. Koenigsknecht, Carmon Helman, Justin Nair, Jayasree Mathew, Bobby Rawat, Munmun Nielsen, Lori Lesneski, Amy L. Hardie, Morgan E. Alhassen, Ziad Joudi, Houssam M. Giusto, Evan M. Zeinali, Lida Knych, Heather K. Weiner, Gary M. Lakshminrusimha, Satyan Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest |
title | Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest |
title_full | Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest |
title_fullStr | Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest |
title_full_unstemmed | Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest |
title_short | Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest |
title_sort | effect of a larger flush volume on bioavailability and efficacy of umbilical venous epinephrine during neonatal resuscitation in ovine asphyxial arrest |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228479/ https://www.ncbi.nlm.nih.gov/pubmed/34205843 http://dx.doi.org/10.3390/children8060464 |
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