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

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article number464
JournalChildren
Volume8
Issue number6
DOIs
StatePublished - Jun 2021

Keywords

  • Asphyxia
  • Cardiac arrest
  • Chest compressions
  • Epinephrine
  • Epinephrine concentrations
  • Flush volume
  • Neonatal resuscitation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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