Abstract 150: Anesthetic Postconditioning With Sevoflurane During Cardiopulmonary Resuscitation Improves Cardiac Mitochondrial Function in a Pig Model of Cardiac Arrest
Introduction: Anesthetic postconditioning (PC) reduces myocardial ischemia/reperfusion (IR) injury.1,2 We hypothesized that sevoflurane (SEV) PC during cardiopulmonary resuscitation (CPR) is similarly effective in improving hemodynamics and post-CPR left ventricular ejection fraction (LVEF) as ischemic PC3 in a pig model of prolonged ventricular fibrillation (VF), and that this is due to better-preserved mitochondrial function.
Methods: Following 15 min of untreated VF, 14 pigs received 4 minutes of CPR with automated compression/decompression and an impedance threshold device before defibrillation. 7/14 animals received 3% SEV for 3 min at the initiation of CPR while the rest did not (CON). LVEF was obtained by echocardiography 12 min after of return of spontaneous circulation (ROSC). Cardiac mitochondria were isolated 15 min after ROSC. Mitochondrial O2 consumption, ATP synthesis, and Ca2+-retention capacity were measured for complex I and II substrates. Statistics: unpaired t-tests; alpha = 0.05 (two-tailed).
Results: ROSC was achieved in all animals. Intra-CPR coronary perfusion pressure and post-ROSC LVEF significantly increased while the number of shocks and the epinephrine dose to achieve ROSC were significantly reduced in SEV vs CON animals. Compared to CON, SEV mitochondria exhibited better maintained ATP synthesis, coupling of oxidative phosphorylation and delayed transition pore opening (table).
Discussion: After prolonged untreated VF cardiac arrest, inhaled SEV given for 3 min at the initiation of CPR dramatically improved hemodynamics and LVEF. The benefit of this novel strategy was linked to cardiac mitochondrial protection and improved mitochondrial functional outcomes. Our findings may have profound clinical implications on future CPR algorithms in humans. Funding: VA (CARA-026-10F), NIH.
References: 1) Br J Anaesth 1996;76(6):860-7. 2) Br J Anaesth 1997;79(1):88-96. 3) Resuscitation 2012;83(11):1397-403.
- Cardiopulmonary resuscitation
- Cardioprotective drugs
- Ischemia reperfusion
- Ventricular fibrillation
- © 2013 by American Heart Association, Inc.