Abstract 110: Bundle Therapy at the Initiation of CPR With Poloxamer 188, Ischemic Postconditioning and Sevoflurane Leads to Cerebral Recovery and Myocardial Protection After 17 Minutes of Untreated Cardiac Arrest
Introduction: Cerebral recovery was considered impossible after 12 minutes of global ischemia until recently. Poloxamer 188 (P188) is a synthetic surfactant known to minimize reperfusion injury (RI). We have previously shown that ischemic postconditioning (IPC) and sevoflurane (SEV) reduce RI in cardiac arrest. We hypothesized that a bundle therapy (BND-CPR) with combination of P188, IPC and SEV at the start of cardiopulmonary resuscitation (CPR) improve survival with good neurologic function at 24-H and reduce vital organs damage after prolonged cardiac arrest.
Methods: Following 15 min of VF, standard CPR was performed in control animals (N=8) and compared to animals that underwent 17 minutes of untreated VF followed by BND-CPR (N=13). BND-CPR constitutes: a) P188: IV bolus (250 mg/kg) at the initiation of CPR followed by an infusion of 250mg/Kg of P188 for 4 hours post-return of spontaneous circulation (ROSC); b) IPC: active compression decompression CPR with an impedance threshold device for 20 sec followed by 20 sec of pause for 3 cycles; and c) SEV: inhalation of SEV 2% for the first 3 min. Epinephrine was used according to standard therapy in all animals. Survival and cerebral performance category score (CPC) 1 & 2 was evaluated at 24H. Troponin, CKMB, creatinine and liver function tests were measured at 4hr. Fischer exact test and unpaired t-tests was used for statistical analysis.
Results: All animals achieved ROSC. Survival to 24-H was 5/8 and 11/13 for the CTL versus BND-CPR animals p=0.3. Survival with good neurologic function with CPC 1 & 2 was higher in BND-CPR vs. CTL at 24-H (7/13 vs. 0/8,) and 48-H (6/13 vs. 0/8, p<0.001 for both). Troponin, CKMB, liver function tests at 4 hour were in favor of BND-CPR group (table).
Conclusion: A bundle therapy that targets reperfusion injury at the mitochondrial and cell membrane level facilitates successful resuscitation of the brain and other vital organs after prolonged untreated cardiac arrest.
- © 2013 by American Heart Association, Inc.