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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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