ArticlePediatric research2026
Comparison of intravenous and intraosseous administration of vasopressin and epinephrine during cardiopulmonary resuscitation of asphyxiated neonatal piglets.
Article in Pediatric research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEpinephrine is currently the only vasopressor recommended during neonatal cardiopulmonary resuscitation (CPR). Previous neonatal animal studies suggested intravenous (IV) vasopressin as a potential alternative; however, no neonatal study has compared the efficacy of intraosseous (IO) with IV vasopressin to epinephrine administration during CPR. DESIGN/
methodsNewborn piglets (n = 8/group) were anesthetized, intubated, surgically instrumented, and exposed to normocapnic hypoxia followed by asphyxia and asystole. Piglets were resuscitated following randomization to 0.4IU/kg IV or IO vasopressin, or 0.02 mg/kg IV or IO epinephrine.
resultsThere were no differences in median (IQR) time to return of spontaneous circulation (ROSC) between IV and IO vasopressin (254 (220-473) vs. 215 (200-240)sec, respectively, p = 0.143), IV and IO epinephrine (272 (265-278) vs. 233 (203-266)sec, respectively, p = 0.286), or all four groups (p = 0.312). The number of piglets that achieved ROSC was similar with IV and IO vasopressin (5 (63%) vs. 3 (38%), respectively, p = 0.619), IV and IO epinephrine (2 (25%) vs. 6 (75%), respectively, p = 0.132), and between all groups (p = 0.233).
conclusionsVasopressin given either via IO or IV had no difference in time to or rates of ROSC compared to IV and IO epinephrine. IMPACT: This is the first neonatal animal study to compare intraosseous (IO) and intravenous (IV) vasopressin during cardiac arrest. Time to and rates of return of spontaneous circulation (ROSC) were similar between IO and IV vasopressin. Time to and incidence of ROSC were not statistically different between vasopressin and epinephrine, regardless of IV or IO administration. Hemodynamic changes during cardiopulmonary resuscitation are similar between vasopressin and epinephrine groups. Plasma vasopressor concentrations were similar between IO and IV routes.
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