Impact of arginine-vasopressin on regional perfusions in a porcine model of post-resuscitation syndrome

• Published in: Resuscitation plus Vol. 18; p. 100654
• Main Authors: Bois, Antoine, Abi Zeid Daou, Yara, Watanabe, Naoto, Jendoubi, Ali, Lidouren, Fanny, Faucher, Estelle, Mouri, Nadir, Ghaleh, Bijan, Geri, Guillaume, Tissier, Renaud, Kohlhauer, Matthias
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2024; Elsevier
• Subjects: Blood flow; Cardiac arrest; Experimental Paper; Life Sciences; Resuscitation; Shock; Vasopressin; Vasopressor; Shock; Vasopressor; Resuscitation; Vasopressin; Cardiac arrest; Blood flow; resuscitation; vasopressor; cardiac arrest; blood flow; shock; vasopressin
• ISSN: 2666-5204; 2666-5204
• DOI: 10.1016/j.resplu.2024.100654

Post-cardiac arrest (CA) shock is associated with multiple organ failure, including acute kidney injury, and is the leading cause of early death among patient successfully resuscitated from CA. Arginine-vasopressin (AVP) may be an interesting therapeutic alternative or complement to noradrenaline (NAD) to both control shock and preserve regional, especially renal, organ perfusions. 18 swine (24–39 kg) were submitted to 14 min of ventricular fibrillation and cardio-pulmonary resuscitation. After return of spontaneous circulation (ROSC), animals randomly received either AVP, NAD or AVP-NAD combination for maintaining a targeted mean arterial pressure of 70 ± 5 mmHg for 6 h. Haemodynamic and biological parameters, including kidney function biomarkers and diuresis, were monitored throughout the follow-up. Targeted mean arterial pressure was successfully obtained in the NAD (n = 6) and the AVP-NAD (n = 6) groups, but not in the AVP group (n = 6), where 4 animals died. As compared to NAD alone, renal blood flow (2.9 ± 1.15 vs 4.36 ± 0.64 mL//kg/min in NAD and AVP-NAD groups) and diuresis were higher in the AVP-NAD group. This was associated with a reduction of carotid blood flow and a more severe metabolic acidosis during the first 3 h of follow-up in the AVP-NAD group as compared to NAD group. Combination of AVP and NAD improved renal perfusion and diuresis but reduced carotid blood flow as compared to NAD alone in a porcine model of post-resuscitation syndrome. AVP alone failed to manage shock and led to mortality.