Beneficial Effects of Terlipressin in Pediatric Cardiac Arrest

Abstract

: Vasopressin and its analog, terlipressin (TP), are potent vasopressors that may be useful therapeutic agents in the treatment of cardiac arrest (CA), septic and catecholamine-resistant shock, and esophageal variceal hemorrhage. The American Heart Association 2000 guidelines recommend its use for adult ventricular fibrillation arrest, and the American Heart Association 2005 guidelines note that it may replace the first or second epinephrine dose. There is little reported experience with TP in cardiopulmonary resuscitation (CPR) of children. The purpose of this retrospective case series was to report successful return of spontaneous circulation after the rescue administration of vasopressin after prolonged CA and failure of conventional CPR, advanced life support, and epinephrine therapy in children. : Nine pediatric patients with asystole, aged 11 months to 14 years, who experienced 12 episodes of refractory CA and did not respond to conventional therapy. Terlipressin was administered as intravenous bolus doses of 20 mcg/kg to standard cardiopulmonary resuscitation. : Return of spontaneous circulation was monitored and achieved in 6 of the 12 episodes. The mean duration of CPR was 24.8 minutes in these 12 episodes of CA with TP administration, with a range of 10 to 50 minutes (median, 23 minutes). Five survivors were discharged home without sequelae and with good neurologic status (score 1 by the pediatric cerebral performance category). : The combination of TP to epinephrine during CPR may have a beneficial effect in children with CA. However, the recommendations for its use in the pediatric literature are based on limited clinical data.