Abstract 12586: Erythropoietin Given during CPR Increases Post-Resuscitation Myocardial O2 Consumption and Reduces Myocardial Stunning
Background: We previously reported in a rat model of VF that erythropoietin (EPO) given during CPR reverses post-resuscitation myocardial dysfunction associated with preservation of cytochrome c oxidase activity; supporting a beneficial effect on energy metabolism and mechanical function. We investigated the myocardial effects of EPO in an open-chest swine model of VF instrumented to measure coronary blood flow; using extracorporeal circulation (ECC) for resuscitation during VF and for circulatory support post-resuscitation.
Methods: VF was induced and left untreated for 8 minutes after which ECC was started and maintained for an additional 10 minutes adjusting the flow to generate a coronary perfusion pressure of 10 mmHg. Defibrillation was accomplished and the ECC flow titrated - as needed - to secure a mean aortic pressure ≥40 mmHg during spontaneous circulation for a maximum of 120 minutes. Sixteen pigs were randomized 1:1 to receive EPO (5,000 U/kg) or 0.9% NaCl during VF before starting ECC.
Results: Post-resuscitation, pigs that received EPO had higher myocardial O2 consumption with preserved myocardial lactate consumption (Table) suggesting that EPO - as in the rat model - had a beneficial effects on mitochondrial energy metabolism. The energy effect was accompanied by less myocardial dysfunction; evidenced by lesser reductions in left ventricular ejection fraction (%) at 120 minutes post-resuscitation relative to baseline in EPO (45±8 vs 36±9; NS) than in NaCl (46±8 vs 26±8; p<0.001) and lesser reductions in peak systolic pressure/end-systolic volume (mmHg/ml) in EPO (2.7±0.8 vs 2.4±0.7; NS) than in NaCl (3.0±1.1 vs 1.8±0.6; p<0.001); effects which were accompanied by higher cardiac index (2.4±1.3 vs 2.0±0.8 l/min·m-2; p=0.036).
Conclusion: EPO administered during resuscitation from VF increased myocardial energy metabolism and mechanical function post-resuscitation suggesting a novel effect of EPO attenuating myocardial stunning.
- Cardiopulmonary resuscitation
- Ventricular fibrillation
- Myocardial contraction
- Myocardial perfusion
- Growth factors
- © 2012 by American Heart Association, Inc.