Abstract 10: Bundled Post-Conditioning Therapy Improves Hemodynamics and Post-Resuscitation Cardiac Function When Administered During the Metabolic Phase of Cardiac Arrest
Introduction: Effective therapies for the metabolic phase of cardiac arrest do not exist currently. We hypothesized that aggressively treating reperfusion injury using bundled therapy (BND) with ischemic post-conditioning (IPC) and sevoflurane plus Poloxamer 188 (P188) would improve resuscitation hemodynamics and reduce post-resuscitation LV dysfunction in a highly lethal model of prolonged cardiac arrest.
Methods: Following 15 min of VF, standard ACLS resuscitation was performed in control animals (N=8) and compared to animals that underwent 17 minutes of untreated VF followed by CPR augmented with BND (N=14), which consisted of (1) IPC: 20 seconds of chest compressions followed by a 20 second pause, repeated for a total for 3 cycles with (2) interval delivery of 2% sevoflurane breaths for 3 min, followed by (3) P188 (250 mg/kg) bolus administered IV with the same dose infused again over 4 hrs post ROSC. Both groups received 0.5 mg epinephrine prior to defibrillation. Systolic (SBP), diastolic (DBP) and right atrial pressure (RAP) were measured continuously and coronary perfusion pressure (CPP) calculated. In animals achieving ROSC, echocardiography was performed at 1 and 4 hrs to assess ejection fraction (EF). Unpaired t-tests were used for comparisons.
Results: SBP, DBP, and CPP were all significantly higher during BND resuscitation (Figure). EF following ROSC was higher in BND animals (63+13 at 1 hr, 61+8 at 4 hrs) vs controls (38+12 at 1 hr, 36+18 at 4 hrs) (p<0.001 for comparisons).
Conclusion: A strategy of bundled post-ischemic conditioning therapies improves hemodynamics during CPR and eliminates post-resuscitation LV dysfunction in this model.
- Reperfusion injury
- Cardiopulmonary resuscitation
- Ventricular fibrillation
- Ejection fraction
- © 2013 by American Heart Association, Inc.