Abstract 20421: Polarizing State Induced by Adenosine, Lidocaine and Magnesium Administration After Prolonged Circulatory Arrest Improves Cardioprotection and Neuroprotection in a Rat Model of Cardiac Arrest With Extracorporeal Life Support
BACKGROUND: Polarized arrest, a new concept of myocardial protection, has been recently demonstrated to improve cardiac function after cardioplegic arrest during cardiac surgery. The present study investigated whether polarizing state after prolonged cardiac arrest would provide cardioprotective and neuroprotective effects after extracorporeal life support (ECLS).
METHODS AND RESULTS: Ventricular fibrillation (VF) was induced in male Wistar rats. After 8 min of untreated VF, veno-arterial ECLS was instituted for 60 min inducing mild therapeutic hypothermia (32°C). At the beginning of ECLS animals were randomized to receive a single iv bolus of 4.5 mL/kg of polarizing solution with adenosine (47 μM), lidocaine (92 μM) and MgSO4 (1 mM) or same volume of saline as control.
Restoration of spontaneous circulation was higher in rats that received polarizing solution (p = 0.03). After 24 h survival and neurologic deficit scores were improved and histological damage scores and brain TNF-α were attenuated compared to control (all p<0.05).
Polarizing solution administration led to better recovery of left ventricle end-systolic pressure-volume relationship (Ees), preload recruitable stroke work (PRSW), end-diastolic pressure-volume relationship (EDPVR) and Tau (p<0.01).
Polarized state enhanced phosphorilation of myocardial ERK1 and 2 and Akt, resulting in a lower apoptotic index (TUNEL, p<0.01).
CONCLUSIONS: Polarized state induced by adenosine, lidocaine and magnesium increased survival, neurologic outcome and cardiac function after prolonged cardiac arrest treated with ECLS. Moreover it improved cardioprotection through activation of the pro-survival kinases Akt and ERK1/2.
Author Disclosures: A. Rungatscher: None. G.P. Dobson: None. D. Linardi: None. E. Milani: None. M. Tessari: None. P.F. Fabene: None. G. Tong: None. K. Schmitt: None. G. Faggian: None.
- © 2014 by American Heart Association, Inc.