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:  Publisher    
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-hour survival. METHODS: Prospective randomized animal study. Following 15minutes of ventricular fibrillation, 42 Yorkshire farm pigs weighing an average of 34±2kg 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 3minutes of CPR with 4 cycles of 20seconds of chest compressions followed by 20-second pauses. CVT consisted of intravenous sodium nitroprusside (2mg) and adenosine (24mg) 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 4hours post-ROSC. The brains were extracted after euthanasia at least 24hours 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). 48hours 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-hour 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-hour survival after 15min of untreated cardiac arrest in pigs. The Institutional Animal Care Committee of the Minneapolis Medical Research Foundation approved the protocol (number 11-05, approved on 5/10/2011).
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     Date:  2013-1-29
Journal Detail:
Title:  Resuscitation     Volume:  -     ISSN:  1873-1570     ISO Abbreviation:  Resuscitation     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-2-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013. Published by Elsevier Ireland Ltd.
Affiliation:
From the Cardiovascular Divisions at the University of Minnesota. Electronic address: yanno001@umn.edu.
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