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(Circulation. 2009;120:897-905.)
© 2009 American Heart Association, Inc.

Resuscitation Science

Nitrite Therapy After Cardiac Arrest Reduces Reactive Oxygen Species Generation, Improves Cardiac and Neurological Function, and Enhances Survival via Reversible Inhibition of Mitochondrial Complex I

Cameron Dezfulian, MD; Sruti Shiva, PhD; Aleksey Alekseyenko, BS; Akshay Pendyal, BS; D.G. Beiser, MD; Jeeva P. Munasinghe, PhD; Stasia A. Anderson, PhD; Christopher F. Chesley; T.L. Vanden Hoek, MD; Mark T. Gladwin, MD

From Pulmonary and Critical Care Medicine, Department of Medicine, and Cerebral Vascular Disease Research Center, Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla (C.D.); Hemostasis and Vascular Biology Research Institute (S.S., M.T.G.) and Department of Pharmacology and Chemical Biology (S.S.), University of Pittsburgh, Pittsburgh, Pa; University of North Carolina School of Medicine, Chapel Hill (A.P.); Emergency Resuscitation Center and Section of Emergency Medicine, University of Chicago, Chicago, Ill (D.G.B., T.L.V.H.); National Institute of Neurological Disorders and Stroke (J.P.M.) and National Heart Lung and Blood Institute Animal Imaging Core (S.A.A.), National Institutes of Health, Bethesda, Md; and Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.T.G.).

Correspondence to Cameron Dezfulian, MD, Assistant Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, R-47 RMSB 7058, 1600 NW 10th Ave, Miami, FL 33136. E-mail cdezfulian{at}med.miami.edu

Received January 27, 2009; accepted June 30, 2009.

Background— Three-fourths of cardiac arrest survivors die before hospital discharge or suffer significant neurological injury. Except for therapeutic hypothermia and revascularization, no novel therapies have been developed that improve survival or cardiac and neurological function after resuscitation. Nitrite (NO₂^–) increases cellular resilience to focal ischemia/reperfusion injury in multiple organs. We hypothesized that nitrite therapy may improve outcomes after the unique global ischemia/reperfusion insult of cardiopulmonary arrest.

Methods and Results— We developed a mouse model of cardiac arrest characterized by 12 minutes of normothermic asystole and a high cardiopulmonary resuscitation rate. In this model, global ischemia and cardiopulmonary resuscitation were associated with blood and organ nitrite depletion, reversible myocardial dysfunction, impaired alveolar gas exchange, neurological injury, and an 50% mortality. A single low dose of intravenous nitrite (50 nmol=1.85 µmol/kg=0.13 mg/kg) compared with blinded saline placebo given at cardiopulmonary resuscitation initiation with epinephrine improved cardiac function, survival, and neurological outcomes. From a mechanistic standpoint, nitrite treatment restored intracardiac nitrite and increased S-nitrosothiol levels, decreased pathological cardiac mitochondrial oxygen consumption resulting from reactive oxygen species formation, and prevented oxidative enzymatic injury via reversible specific inhibition of respiratory chain complex I.

Conclusion— Nitrite therapy after resuscitation from 12 minutes of asystole rapidly and reversibly modulated mitochondrial reactive oxygen species generation during early reperfusion, limiting acute cardiac dysfunction, death, and neurological impairment in survivors.

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Clinical Summaries
Circulation 2009 120: 823-824. [Extract] [Full Text]