ArticleArchives of disease in childhood. Fetal and neonatal edition2021
Randomised trial of epinephrine dose and flush volume in term newborn lambs.
Article in Archives of disease in childhood. Fetal and neonatal edition, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- RECOVER Guidelines: Newborn Resuscitation in Dogs and Cats. Evidence and Knowledge Gap Analysis With Treatment Recommendations.Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001) · 2025Pooled it
- Advanced Resuscitation with an Intact Cord in Preterm Lambs: A Feasibility Trial.Children (Basel, Switzerland) · 2026Article
- Randomised trial of early rapid saline bolus versus epinephrine during resuscitation in perinatal haemorrhagic cardiac arrest in newborn lambs.Archives of disease in childhood. Fetal and neonatal edition · 2026Article
- Resuscitation after birth and beyond in the neonatal intensive care unit: NRP or PALS?Journal of perinatology : official journal of the California Perinatal Association · 2025Review
- Pharmacokinetic and pharmacodynamic evaluation of various vasopressin doses and routes of administration in a neonatal piglet model.Scientific reports · 2024Article
- Direct Umbilical Vein Injection of Epinephrine with Cut-Cord Milking in an Ovine Model of Neonatal Resuscitation.Children (Basel, Switzerland) · 2024Article
- Femoral Occlusion during Neonatal Cardiopulmonary Resuscitation Improves Outcomes in an Ovine Model of Perinatal Cardiac Arrest.Children (Basel, Switzerland) · 2023Article
- Optimal oxygen use in neonatal advanced cardiopulmonary resuscitation-a literature review.Pediatric medicine (Hong Kong, China) · 2023Article
- Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs.Children (Basel, Switzerland) · 2023Article
- Masked Randomized Trial of Epinephrine versus Vasopressin in an Ovine Model of Perinatal Cardiac Arrest.Children (Basel, Switzerland) · 2023Article
- Is epinephrine effective during neonatal resuscitation?Pediatric research · 2023Article
- Chest compression rates of 60/min versus 90/min during neonatal cardiopulmonary resuscitation: a randomized controlled animal trial.Frontiers in pediatrics · 2023Article
- Chest Compression Rates of 90/min versus 180/min during Neonatal Cardiopulmonary Resuscitation: A Randomized Controlled Animal Trial.Children (Basel, Switzerland) · 2022Article
- Physiology of neonatal resuscitation: Giant strides with small breaths.Seminars in perinatology · 2022Review
- Role of Volume Replacement during Neonatal Resuscitation in the Delivery Room.Children (Basel, Switzerland) · 2022Review
- Recent Update on Neonatal Resuscitation.Indian journal of pediatrics · 2022Review
- Singapore Neonatal Resuscitation Guidelines 2021.Singapore medical journal · 2021Article
- Randomized Trial of Oxygen Saturation Targets during and after Resuscitation and Reversal of Ductal Flow in an Ovine Model of Meconium Aspiration and Pulmonary Hypertension.Children (Basel, Switzerland) · 2021Article
- What is the optimal initial dose of epinephrine during neonatal resuscitation in the delivery room?Journal of perinatology : official journal of the California Perinatal Association · 2021Review
- Effect of a Larger Flush Volume on Bioavailability and Efficacy of Umbilical Venous Epinephrine during Neonatal Resuscitation in Ovine Asphyxial Arrest.Children (Basel, Switzerland) · 2021Article
Corrections and comments
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Authors and funding
12 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesNeonatal resuscitation guidelines recommend 0.5-1 mL saline flush following 0.01-0.03 mg/kg of epinephrine via low umbilical venous catheter for persistent bradycardia despite effective positive pressure ventilation (PPV) and chest compressions (CC). We evaluated the effects of 1 mL vs 3 mL/kg flush volumes and 0.01 vs 0.03 mg/kg doses on return of spontaneous circulation (ROSC) and epinephrine pharmacokinetics in lambs with cardiac arrest.
designForty term lambs in cardiac arrest were randomised to receive 0.01 or 0.03 mg/kg epinephrine followed by 1 mL or 3 mL/kg flush after effective PPV and CC. Epinephrine (with 1 mL flush) was repeated every 3 min until ROSC or until 20 min. Haemodynamics, blood gases and plasma epinephrine concentrations were monitored.
resultsTen lambs had ROSC before epinephrine administration and 2 died during instrumentation. Among 28 lambs that received epinephrine, 2/6 in 0.01 mg/kg-1 mL flush, 3/6 in 0.01 mg/kg-3 mL/kg flush, 5/7 in 0.03 mg/kg-1 mL flush and 9/9 in 0.03 mg/kg-3 mL/kg flush achieved ROSC (p=0.02). ROSC was five times faster with 0.03 mg/kg epinephrine compared with 0.01 mg/kg (adjusted HR (95% CI) 5.08 (1.7 to 15.25)) and three times faster with 3 mL/kg flush compared with 1 mL flush (3.5 (1.27 to 9.71)). Plasma epinephrine concentrations were higher with 0.01 mg/kg-3 mL/kg flush (adjusted geometric mean ratio 6.0 (1.4 to 25.7)), 0.03 mg/kg-1 mL flush (11.3 (2.1 to 60.3)) and 0.03 mg/kg-3 mL/kg flush (11.0 (2.2 to 55.3)) compared with 0.01 mg/kg-1 mL flush.
conclusions0.03 mg/kg epinephrine dose with 3 mL/kg flush volume is associated with the highest ROSC rate, increases peak plasma epinephrine concentrations and hastens time to ROSC. Clinical trials evaluating optimal epinephrine dose and flush volume are warranted.
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