Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest
Deepika Sankaran,
Payam Vali,
Praveen Chandrasekharan,
Peggy Chen,
Sylvia F. Gugino,
Carmon Koenigsknecht,
Justin Helman,
Jayasree Nair,
Bobby Mathew,
Munmun Rawat,
Lori Nielsen,
Amy L. Lesneski,
Morgan E. Hardie,
Ziad Alhassen,
Houssam M. Joudi,
Evan M. Giusto,
Lida Zeinali,
Heather K. Knych,
Gary M. Weiner,
Satyan Lakshminrusimha
Affiliations
Deepika Sankaran
Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
Payam Vali
Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
Praveen Chandrasekharan
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA
Peggy Chen
Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
Sylvia F. Gugino
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA
Carmon Koenigsknecht
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA
Justin Helman
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA
Jayasree Nair
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA
Bobby Mathew
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA
Munmun Rawat
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA
Lori Nielsen
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA
Amy L. Lesneski
Department of Stem Cell Research, University of California, Davis, Sacramento, CA 95817, USA
Morgan E. Hardie
Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
Ziad Alhassen
Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
Houssam M. Joudi
Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
Evan M. Giusto
Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
Lida Zeinali
Department of Pediatrics, University at Buffalo, Buffalo, NY 14203, USA
Heather K. Knych
Department of Molecular Biosciences, Davis School of Veterinary Medicine, University of California, Davis, CA 95616, USA
Gary M. Weiner
Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
Satyan Lakshminrusimha
Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
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.
