Epinephrine versus saline volume expansion in neonatal resuscitation: a blinded randomized piglet study

The aim of this study was to compare a normal saline bolus versus epinephrine during resuscitation on mortality and brain injury assessed by magnetic resonance spectroscopy (MRS) in newborn piglets.

Thirty-two newborn piglets were subjected to hypoxic cardiac arrest and randomized to resuscitation with epinephrine (0.01 mg/kg, n = 16) or saline bolus (0.9%, 10 mL/kg, n = 16). A sham group received no intravenous treatment (n = 8). Brain MRS and magnetic resonance imaging (MRI) were performed 18 h after resuscitation. The primary outcome was a composite of death or severe brain damage determined by MRS. Secondary outcomes were mortality, time to return of spontaneous circulation (ROSC), and MRI/MRS measures of brain injury.

There was no difference between piglets resuscitated with saline bolus vs. epinephrine in the primary outcome (RR: 0.94, 95% CI: 0.56, 1.58). The two groups were also similar with regards to mortality, time to ROSC, and MRS/MRI-outcomes. Sham piglets had a higher mortality (RR: 1.50, 95% CI: 0.88, 2.55) than intravenous treatment groups, although not statistically significant.

Saline bolus during resuscitation was as effective as epinephrine in preventing death and brain injury, as determined by MRS. Saline bolus may be a relevant alternative to epinephrine during neonatal resuscitation.

Saline bolus is as effective as epinephrine in achieving return of spontaneous circulation in newborn piglets with hypoxic cardiac arrest. Saline bolus and epinephrine result in similar brain outcomes measured by magnetic resonance spectroscopy at 18 h. Saline bolus and epinephrine achieve similar time to return of spontaneous circulation and 18-h survival. This study adds to the limited evidence regarding the effect of saline volume expansion during neonatal resuscitation and underlines the need for clinical trials.