Abstract 68: The Combination of Adenosine and Lidocaine (Adenocaine) Improves Postresuscitation Cardiac Function Following Cardiac Arrest
Introduction: Despite return of spontaneous circulation (ROSC), mortality after cardiac arrest is high. ROSC elicits an inflammatory response due to global ischemia-reperfusion (I-R) which affects organ function. Adenosine (Ado) and Lidocaine (Lido) possess anti-inflammatory properties, and the combination improves cardiac function after myocardial I-R. The aim of the study is to determine if a combination of Adenosine and Lido (Adenocaine) in a porcine model of cardiac arrest reduces postresuscitation injury.
Methods: Pigs were randomized to: 1) Control (n=12) or 2) Adenocaine (Ado 0.82mg/kg Lido 1.66mg/kg; n=9). After 7 minutes of electrically induced ventricular fibrillation, pigs were resuscitated with standardized chest compressions and epinephrine (EPI), with attempted defibrillation every two minutes. Adenocaine was infused over 3 mins, 30 seconds after start of resuscitation. Cardiodynamics were assessed throughout the study; Pigs were neurologically scored (0 = normal;−500 = brain dead) after 24hrs.
Results: ROSC was achieved in 67% of pigs in both groups. Time to ROSC: 455 ± 356 sec in control vs. 340 ± 140 sec in Ado, and the EPI dose: control (1.65 ± 1.14 mg) and Ado (1.06 ± 0.55 mg) was comparable between groups. Arrest caused a significant decrease in ejection fraction (EF) (Table), without group differences. Cardiac index returned to baseline levels at an earlier time point in the Adenocaine group (p<0.001). End-systolic pressure was not different between groups. However, end-diastolic pressure (EDP) was lower (p<0.001) and LV dP/dtmax and LV dp/dtmin(p<0.002) was higher in Adenocaine than Control, suggesting maintenance of cardiac function at normal EDP. Neurological deficit scores were low in both groups Control (29.3 ± 30.7) and Adenocaine (48.3 ± 62.5).
Conclusions: Adenocaine increased dP/dtmax and dp/dtmin and maintained EF without LV dilatation (lower EDP) at comparable arterial pressures, with no difference in neurological score.
- © 2010 by American Heart Association, Inc.