Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000600005
Brazilian Journal of Anesthesiology
Scientific Article

A eficácia da terlipressina versus adrenalina na ressuscitação cardiopulmonar em suínos

The efficacy of terlipressin versus adrenaline in swine cardiopulmonary resuscitation

Carlos Cezar Ivo Sant'Ana Ovalle; Marcos Mello Moreira; Luiz Claudio Martins; Sebastião Araujo

http://dx.doi.org/10.1590/S0034-70942011000600005 Braz J Anesthesiol, vol.61, n6, p.732-735, 2011
PDF Português
PDF English
Downloads: 0
Views: 1075

Resumo

JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi avaliar a eficácia da terlipressina (TP) versus adrenalina (ADR) em aumentar a pressão de perfusão coronariana (PPC) e o retorno da circulação espontânea (RCE) na RCP em suínos. MÉTODOS: Sob anestesia cetamina/tiopental, induziu-se fibrilação ventricular em 44 porcos fêmeas imaturos, permanecendo não assistida por 10 min, seguidos de 2 min de RCP-manual (100 compressões/10 ventilações/min com ar). Os animais foram então alocados em quatro grupos, recebendo: 1) ADR (45 µg.kg-1); 2) salina-placebo (10 mL); 3) TP (20 µg.kg-1); 4) TP (20 µg.kg-1) + ADR (45 µg.kg-1). Desfibrilação foi realizada 2 min após, observando-se os animais sobreviventes por um período de 30 min. ECG, PA sistêmica, PAD e PetCO2 foram monitorados continuamente. RESULTADOS: A TP não diferiu do placebo quanto aos efeitos na PPC, com baixas taxas de RCE em ambos os grupos (1/11 vs.2/11; p = NS). A ADR aumentou a PPC de 13 ± 12 para 54 ± 15 mmHg (p < 0,0001), efeito similar a TP + ADR (de 21 ± 10 para 45 ± 13 mmHg; p < 0,0001), com altas taxas de RCE/sobreviventes em ambos os grupos (10/11 vs.9/11, respectivamente). Entre os sobreviventes, maior PAM foi observada no grupo TP + ADR vs.ADR (105 ± 19 mmHg vs.76 ± 21 mmHg; p = 0,0157). CONCLUSÕES: ADR e TP + ADR foram efetivas para aumentar a PPC/RCE neste modelo experimental, mas a TP, isolada, não foi diferente do placebo. Contudo, nos animais sobreviventes do grupo TP + ADR observou-se maior estabilidade hemodinâmica após a RCE, sugerindo que a TP possa ser uma medicação útil no manuseio da hipotensão pós-RCP.

Palavras-chave

ANIMAL, DROGAS, Epinefrina, Arginina Vasopressina, REANIMAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: The objective of the present study was to evaluate the efficacy of terlipressin (TP) vs.adrenaline (ADR) in increasing coronary perfusion pressure (CPP) and return of spontaneous circulation (ROSC) in swine CPR. METHODS: Under anesthesia with ketamine/thiopental, ventricular fibrillation was induced in 44 female immature pigs, remaining unassisted for 10 minutes, followed by 2 minutes of manual CPR (100 compression/10 ventilations/min with air). Animals were, then, divided into four groups: 1) ADR (45 µg.kg-1); 2) saline-placebo (10 mL); 3) TP 20 µg.kg-1); and TP (20 µg.kg-1) + ADR (45 µg.kg-1). Defibrillation was performed after 2 minutes, observing surviving animals for a 30-minute period. Electrocardiogram, systemic BP, DBP, and PetCO2 were monitored continuously. RESULTS: Terlipressin did not differ from placebo regarding the effects on CPP, with low rates of ROSC in both groups (1/11 vs.2/11; p = NS). Adrenaline increased CPP from 13 ± 12 to 54 ± 15 mmHg (p < 0.0001), similar effect to TP + ADR (from 21 ± 10 to 45 ± 13 mmHg; p < 0.0001), with high rates of ROSC/survivors in both groups (10/11 vs.9/11, respectively). Among survivors, greater MAP was observed in the TP + ADR group vs.ADR (105 ± 19 mmHg vs.76 ± 21 mmHg; p = 0.0157) groups. CONCLUSIONS: Adrenaline and TP + ADR were effective on maintaining CPP/ROSC in this experimental model, but isolated TP did not differ from placebo. However, in surviving animals in the TP + ADR group, greater hemodynamic stability was observed after ROSC, suggesting that TP can be a useful medication in the management of post-CPR hypotension.

Keywords

Ventricular Fibrillation, Cardiopulmonary Resuscitation, Epinephrine, Arginine Vasopressin

References

Neumar RW, Otto CW, Link MS. Part 8: Adult Advanced Cardiovascular Life Support: 2010 American Heart Association for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122:S729-767.

Gomes AMCG, Timerman A, Souza CAM. In-hospital postcardiopulmonary-cerebral resuscitation survival prognostic factors. Arq Bras Cardiol. 2005;85:262-271.

Singer M. Arginine-vasopressin vs.terlipressin in the treatment of shock states. Best Pract Res Clin Anaesthesiol. 2008;22:359-368.

Morelli A, Ertmer C, Rehberg S. Continuous terlipressin versus vasopressin infusion in septic shock (TERLIVAP): a randomized controlled pilot study. Crit Care. 2009;13.

Matok I, Vardi A, Augarten A. Beneficial effects of terlipressin in prolonged pediatric cardiopulmonary resuscitation: A case series. Crit Care Med. 2007;35:1161-1164.

Gil-Antón J, López-Herce J, Morteruel E. Pediatric cardiac arrest refractory to advanced life support: Is there a role for terlipressin?. Pediatr Crit Care Med. 2010;11:139-141.

López-Herce J, Fernández B, Urbano J. Terlipressin versus adrenaline in an infant animal model of asphyxial cardiac arrest. Intensive Care Med. 2010;36:1248-1255.

Liu D, Shao Y, Luan X. Comparison of ketamine-pentobarbital anesthesia and fentanyl-pentobarbital anesthesia for open-heart surgery in minipigs. Lab Anim. 2009;38:234-240.

Sillberg VAH, Perry JJ, Stiell IC. Is the combination of vasopressin and epinephrine superior to repeated doses of epinephrine alone in the treatment of cardiac arrest: A systematic review. Resuscitation. 2008;79:380-386.

Kam PC, Williams S, Yoong FF. Vasopressin and terlipressin: pharmacology and its clinical relevance. Anaesthesia. 2004;59:993-1001.

5dd683770e8825923fc8fca6 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections