Anest. intenziv. Med. 2011;22(6):328-336

The effect of terlipressin on vital organ perfusion in cardiopulmonary resuscitation - experimental study TERCA (Terlipressin in Cardiac Arrest)Intensive Care Medicine - Original Paper

Truhlář Anatolij^1,2,*, Turek Zdeněk¹, Škulec Roman^1,3, Černý Vladimír^1,4

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové

² Zdravotnická záchranná služba Královéhradeckého kraje, Hradec Králové

³ Územní středisko záchranné služby Středočeského kraje, Beroun

⁴ Department of Anesthesia, Dalhousie University, Halifax, Nova Scotia, Canada

Objective:
Vasoactive drugs are used in cardiopulmonary resuscitation to increase vital organ perfusion. The aim of this study was to compare the haemodynamic effects of synergistically acting terlipressin and adrenaline vs. adrenaline alone in a porcine model of ventricular fibrillation (VF).

Design:
Randomized, double-blinded, placebo controlled experimental study.
Setting:
Department of Anaesthesiology and Intensive Care Medicine, University Hospital; Animal Research Laboratory, Faculty of Military Health Sciences
Materials and methods:
Fourteen domestic pigs were randomly assigned into group TER (n = 7) and ADR (n = 7). VF was induced using an intra-cardiac pacing lead. After 5 min of untreated arrest, compression-only resuscitation was applied for 10 min, followed by advanced life support. Terlipressin in a single-dose of 30 μg .kg^-1 was added to the first dose of adrenaline in group TER, while placebo was given in group ADR. Coronary (CorPP) and cerebral (CPP) perfusion pressures were calculated from the right atrial, aortic and intracerebral pressures. Data were analysed using repeated measurements ANOVA and a Fisher's protected LSD post hoc test.

Results:
Terlipressin/adrenaline maintained CorPP higher than 10 mm Hg for 17.7 min longer than adrenaline alone (P = 0.003). CorPP (mean ± SD) measured at 35, 45, and 55 min after the onset of VF was 12.2 ± 4.0, 11.0 ± 6.2, and 9.6 ± 4.5 mm Hg in group TER; and 5.8 ± 3.8, 0.6 ± 4.9, and -1.0 ± 4.5 mm Hg in group ADR (P = 0.03, < 0.001, and < 0.001). CPP measured at the same times was 23.0 ± 7.2, 20.4 ± 6.9, and 23.1 ± 6.7 mm Hg in group TER; and 13.3 ± 6.5, 6.2 ± 5.3, and 5.6 ± 6.5 mm Hg in group ADR (P = 0.01, < 0.001, and < 0.001).

Conclusion:
A single dose of terlipressin, when added to adrenaline in cardiopulmonary resuscitation, was effective for achieving significantly higher cerebral and coronary perfusion pressures compared to adrenaline alone, which was unable to prevent severe refractory hypoperfusion.

Keywords: cardiopulmonary resuscitation; cardiac arrest; ventricular fibrillation; therapy; terlipressin; cerebral perfusion pressure; coronary perfusion pressure

Received: July 7, 2011; Accepted: November 11, 2011; Published: December 1, 2011  Show citation