Document Detail


Ischemic post-conditioning and vasodilator therapy during standard cardiopulmonary resuscitation to reduce cardiac and brain injury after prolonged untreated ventricular fibrillation.
MedLine Citation:
PMID:  23376583     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM OF THE STUDY: We investigated the effects of ischemic postconditioning (IPC) with and without cardioprotective vasodilatory therapy (CVT) at the initiation of cardiopulmonary resuscitation (CPR) on cardio-cerebral function and 48-h survival.
METHODS: Prospective randomized animal study. Following 15 min of ventricular fibrillation, 42 Yorkshire farm pigs weighing an average of 34 ± 2 kg were randomized to receive standard CPR (SCPR, n=12), SCPR+IPC (n=10), SCPR+IPC+CVT (n=10), or SCPR+CVT (n=10). IPC was delivered during the first 3 min of CPR with 4 cycles of 20s of chest compressions followed by 20-s pauses. CVT consisted of intravenous sodium nitroprusside (2mg) and adenosine (24 mg) during the first minute of CPR. Epinephrine was given in all groups per standard protocol. A transthoracic echocardiogram was obtained on all survivors 1 and 4h post-ROSC. The brains were extracted after euthanasia at least 24h later to assess ischemic injury in 7 regions. Ischemic injury was graded on a 0-4 scale with (0=no injury to 4 ≥ 50% neural injury). The sum of the regional scores was reported as cerebral histological score (CHS). 48 h survival was reported.
RESULTS: Post-resuscitation left ventricular ejection (LVEF) fraction improved in SCPR+CVT, SCPR+IPC+CVT and SCPR+IPC groups compared to SCPR (59% ± 9%, 52% ± 14%, 52% ± 14% vs. 35% ± 11%, respectively, p<0.05). Only SCPR+IPC and SCPR+IPC+CVT, but not SCPR+CVT, had lower mean CHS compared to SCPR (5.8 ± 2.6, 2.8 ± 1.8 vs. 10 ± 2.1, respectively, p<0.01). The 48-h survival among SCPR+IPC, SCPR+CVT, SCPR+IPC+CVT and SCPR was 6/10, 3/10, 5/10 and 1/12, respectively (Cox regression p<0.01).
CONCLUSIONS: IPC and CVT during standard CPR improved post-resuscitation LVEF but only IPC was independently neuroprotective and improved 48-h survival after 15 min of untreated cardiac arrest in pigs.
Authors:
Demetris Yannopoulos; Nicolas Segal; Timothy Matsuura; Mohammad Sarraf; Marit Thorsgard; Emily Caldwell; Jennifer Rees; Scott McKnite; Karen Santacruz; Keith G Lurie
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-29
Journal Detail:
Title:  Resuscitation     Volume:  84     ISSN:  1873-1570     ISO Abbreviation:  Resuscitation     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-15     Completed Date:  2014-04-08     Revised Date:  2014-08-04    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  1143-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adenosine / administration & dosage
Animals
Brain Ischemia* / etiology,  pathology,  physiopathology,  prevention & control
Cardiotonic Agents / administration & dosage
Disease Models, Animal
Echocardiography
Epinephrine / administration & dosage
Heart Arrest* / diagnosis,  etiology,  physiopathology,  therapy
Ischemic Postconditioning / methods*
Models, Cardiovascular
Nitroprusside / administration & dosage
Stroke Volume / drug effects
Swine
Time Factors
Treatment Outcome
Vasoconstrictor Agents / administration & dosage
Vasodilator Agents / administration & dosage*
Ventricular Fibrillation / complications*
Ventricular Function, Left / drug effects*
Grant Support
ID/Acronym/Agency:
R01 HL108926/HL/NHLBI NIH HHS; R01 HL108926-01/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Vasoconstrictor Agents; 0/Vasodilator Agents; 169D1260KM/Nitroprusside; K72T3FS567/Adenosine; YKH834O4BH/Epinephrine
Comments/Corrections

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