IV vs. IO: Can Vasopressin Match Epinephrine in Neonatal CPR?

Comparison of intravenous and intraosseous administration of vasopressin and epinephrine during cardiopulmonary resuscitation of asphyxiated neonatal piglets

During neonatal cardiopulmonary resuscitation (CPR), every second counts. The timely delivery of vasopressors is vital, yet gaining vascular access—especially in a fragile newborn—can be a major barrier. Epinephrine remains the only recommended vasopressor, but vasopressin is emerging as a possible alternative, particularly due to its unique vasoconstrictive properties and longer half-life.

In this study, we explored two key questions:

1. Can vasopressin be as effective as epinephrine during CPR in asphyxiated neonates?

2. Does intraosseous (IO) administration—a faster and technically simpler route than intravenous (IV)—deliver comparable results?

Study Design

Newborn piglets were exposed to normocapnic hypoxia and asphyxia to simulate neonatal arrest, then randomized to receive:

• IV vasopressin (0.4 IU/kg)

• IO vasopressin (0.4 IU/kg)

• IV epinephrine (0.02 mg/kg)

• IO epinephrine (0.02 mg/kg)

All animals underwent standardized neonatal CPR protocols. The primary outcomes were time to return of spontaneous circulation (ROSC) and the rate of successful ROSC.

Key Findings

• No significant difference in time to ROSC across all four groups.

  • IV vasopressin: 254 sec | IO vasopressin: 215 sec

  • IV epinephrine: 272 sec | IO epinephrine: 233 sec

• ROSC rates were similar within drug and route groups:

  • Vasopressin: IV (63%) vs. IO (38%)

  • Epinephrine: IV (25%) vs. IO (75%)

What Does This Mean?

While small sample sizes limit definitive conclusions, these results suggest:

• Intraosseous administration is a feasible alternative to intravenous delivery for both vasopressin and epinephrine during neonatal CPR.

• Vasopressin and epinephrine demonstrated similar effectiveness, regardless of administration route.

Why It Matters

In emergencies where IV access is delayed or impossible, IO delivery may be a lifesaving option, offering rapid drug administration with minimal technical requirements. Furthermore, these findings support further investigation into vasopressin as a potential vasopressor alternative during neonatal resuscitation.

As neonatal resuscitation protocols continue to evolve, flexibility and speed in drug delivery methods—without compromising efficacy—will be crucial to improving outcomes for newborns requiring CPR.