Dextrose with Insulin During Neonatal Resuscitation for Prolonged Asphyxia in a Near-Term Ovine Model: A Proof-of-Concept Study

Highlights: What is the main findings? In this proof-of-concept study using a near-term ovine model of prolonged asphyxia cardiac arrest, co-administration of dextrose and insulin with epinephrine was associated with a higher incidence of return of spontaneous circulation (ROSC) compared to epinephrine alone. What is the implication of the main findings? Administration of dextrose/insulin with epinephrine may offer therapeutic benefits for cardiac resuscitation following prolonged perinatal asphyxia. However, due to the small sample size and lack of statistical significance, larger translational studies are necessary to confirm these findings and establish the clinical potential of this metabolic resuscitation strategy. Background: Neonatal myocytes rely predominantly on glycolytic metabolism for survival during hypoxic conditions. During asphyxia, metabolic pathway dysregulation impairs cardiac myocyte contractility. Co-administration of dextrose and insulin may help restore metabolic homeostasis and improve cardiac function. Methods: Following blinded randomization and instrumentation, near-term lambs (138–140 days gestational age) were asphyxiated by umbilical cord occlusion until complete cardiac arrest, followed by 7 min of continued arrest to model severe asphyxia. Return of spontaneous circulation (ROSC) was defined as heart rate ≥ 100 beats per minute (bpm) and diastolic blood pressure ≥ 20 mmHg. Results: The incidence of ROSC was 3/6 in the control group compared to 5/5 in the experimental group receiving dextrose–insulin therapy, although this difference did not reach statistical significance. Conclusions: In this proof-of-concept study using a near-term ovine model of prolonged asphyxial cardiac arrest, dextrose and insulin co-administered with epinephrine were associated with improved ROSC rates although could be an association.