Evidence map›Paper›PMID 41819786›Full record

ArticleArchives of disease in childhood. Fetal and neonatal edition2026

Randomised trial of early rapid saline bolus versus epinephrine during resuscitation in perinatal haemorrhagic cardiac arrest in newborn lambs.

Deepika Sankaran, Payam Vali, Evan Giusto, Erin Riley, Michelle Lim, Rebecca Valdez, Amy L Lesneski, Jessa Li, Emily Lane, Sylvia Bowditch and 5 more

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In one paragraph

Article in Archives of disease in childhood. Fetal and neonatal edition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Deepika SankaranDepartment of Pediatrics, University of California Davis, Sacramento, California, USA dsankaran@ucdavis.edu.ORCID http://orcid.org/0000-0002-6704-6949
Payam ValiDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.
Evan GiustoDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.
Erin RileyDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.
Michelle LimDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.
Rebecca ValdezDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.
Amy L LesneskiDepartment of Stem Cell Research, University of California Davis, Davis, California, USA.
Jessa LiDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.
Emily LaneDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.
Sylvia BowditchDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.
Victoria HammittDepartment of Stem Cell Research, University of California Davis, Davis, California, USA.
Michele PersianiDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.
Evan MaherDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.
Gary WeinerPediatrics-Neonatal, University of Michigan Hospital, Ann Arbor, Michigan, USA.
Satyan LakshminrusimhaDepartment of Pediatrics, University of California Davis, Sacramento, California, USA.

Funding

Optimal Oxygenation in Neonatal Lung InjuryR01HD072929 · NICHD · UNIVERSITY OF CALIFORNIA AT DAVIS · PI Satyanarayana Lakshminrusimha · 2012 to 2026
$5.4M
OPTImal vasoPRESsor in persistent pulmonary hypertension of the newborn (OPTIPRES)K08HL181183 · NHLBI · UNIVERSITY OF CALIFORNIA AT DAVIS · PI Deepika Sankaran · 2025 to 2026
$330k
Neonatal Hypovolemic Cardiac Arrest: Role of Early Rapid Volume ResuscitationR03HD109443 · NICHD · UNIVERSITY OF CALIFORNIA AT DAVIS · PI SANKARAN, DEEPIKA · 2023 to 2023
$160k
NHLBI NIH HHS K08 HL181183NICHD NIH HHS R01 HD072929NICHD NIH HHS R03 HD109443
6 · The paper itself

Abstract

objectiveTo determine the impact of early rapid saline bolus during resuscitation on (1) time to achieve return of spontaneous circulation (ROSC), and (2) systemic haemodynamics, oxygenation, myocardial stress markers and pulmonary oedema.

designRandomised controlled trial.

settingLamb delivery suite. SUBJECTS: Term lambs in haemorrhagic, asphyxial cardiac arrest.

interventionsFetal lambs were exsanguinated (~45 mL/kg) followed by umbilical cord occlusion to arrest. After 5 min of asystole, ventilation was followed by coordinated chest compressions. Asystolic lambs were randomised to epi-first (intravenous epinephrine, 0.02 mg/kg and if no ROSC, a 10 mL/kg saline bolus over 5 min), or bolus-first (10 mL/kg saline bolus over 2 min and if no ROSC, followed by intravenous epinephrine). Haemodynamics and blood gases were monitored.

resultsIn the epi-first group, none of the lambs achieved ROSC after epinephrine; ROSC occurred in 11/11 lambs during or immediately after saline bolus. In the bolus-first group, none of the lambs achieved ROSC with bolus alone and 8/9 lambs had ROSC after epinephrine. Mean time to ROSC from start of resuscitation was shorter in epi-first (4.9±1.3 vs 6.6±0.9 min, p=0.004), but time to ROSC from the time of epinephrine administration was shorter with bolus-first (86±43 vs 40±21 s, p=0.004). The fetal heart rate did not change significantly despite fetal blood loss.

conclusionsOur findings support current neonatal resuscitation guidelines of intravenous epinephrine followed by a bolus in neonates with suspected hypovolaemic arrest. Early saline bolus delays epinephrine and ROSC. Careful clinical assessment of haemodynamics in the post-resuscitation phase is critical.

Indexed as

Intensive Care Units, NeonatalNeonatologyPaediatricsPhysiologyResuscitation

Identifiers

PMID41819786
PMCPMC13242162

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.