Pediatric cardiac arrest refractory to advanced life support: Is there a role for terlipressin?

Objective: Pediatric cardiac arrest unresponsive to advanced life support and several adrenaline doses has a very poor prognosis. Alternative vasopressors could improve the results of resuscitation in such cases. We report our experience with the compassionate administration of terlipressin in children who suffered in-pediatric intensive care unit cardiac arrest and did not respond to immediate advanced life support and at least three epinephrine doses. Design: Prospective multicenter registry. Setting. Three pediatric intensive care units at university-affiliated tertiary care children's hospitals. Patients. Five pediatric patients, aged 5 mos to 12 yrs, with in-pediatric intensive care unit cardiac arrest unresponsive to advanced life support that included at least three epinephrine doses. Interventions: Addition of terlipressin (10-20 mu g/kg intravenous, up to two doses) to standard cardiopulmonary resuscitation. Measurements and Main Results: Sustained return of spontaneous circulation was achieved in four cases, two of them were declared dead 6 and 12 hrs later, and the remaining two survived without cardiopulmonary procedures-related sequelae and with good neurologic condition. Conclusions. Terlipressin might contribute to obtain sustained return of spontaneous circulation in children with refractory in-hospital cardiac arrest. A randomized controlled clinical trial should be conducted to investigate the optimal drug treatment in pediatric cardiac arrest. (Pediatr Crit Care Med 2010; 11:139-141)