Abstract 17892: Effects of Systemic Pyruvate on Cerebral and Systemic Hemodynamics in Newborn Lambs Following Asphyxial Cardiac Arrest
Introduction: Infants with perinatal depression often require cardiopulmonary resuscitation. Mitochondrial failure to generate ATP during hypoxia-ischemia (HI) & release of reactive oxygen species during reperfusion contributes to cellular damage. Pyruvate alters the fundamental bioenergetics of mitochondria at the early phase of HI & hence may have long-term implications on inflammation & repair providing cardio- and neuroprotection following cardiac arrest (CA).
Hypothesis: We hypothesize that systemic pyruvate in the immediate post recovery phase of CA would improve cardiac function, systemic hemodynamics and oxygen utilization by the brain in newborn lambs with asphyxial CA.
Methods: Term lambs were exteriorized by C-section, instrumented & delivered. Asphyxia induced by cord occlusion (CO) along with ETT clamping. CO / ETT clamped until HR of zero (7 - 15min); CA maintained for 5min. The lambs were resuscitated after CA until ROSC. On stabilization, Pyruvate (LD - 100mg/kg over 10min; infusion - 1mM/kg/min) or saline was infused post-CA for 90min; lambs were ventilated & maintained for 2h post-infusion. Lambs monitored for pulmonary, systemic hemodynamics, ABGs & carotid blood flow.
Results: We had 3 lambs in the pyruvate infusion (PI) group and 3 in the control group. Higher lactate & BE were observed in the PI group. Stroke volume was significantly higher in the PI group, particularly at 180min and at 240min (Figure 1). However, cerebral metabolic rate of oxygen (CMRO2) was not significantly different between the groups at any time points. Significantly higher Na load was noted in the PI group (139.7 ± 3.7 in PI vs 135.8 ± 1meq/L) compared to control grp.
Conclusions: Pyruvate infusion may contribute to higher stroke volume following post-asphyxial cardiac arrest. Stabilization of systemic hemodynamics may have a favorable impact on cerebral blood flow & cerebral metabolism. Effects of pyruvate on cerebral metabolism needs to be explored further.
- Cardiac arrest
- Return of spontaneous circulation (ROSC)
- Systems physiology
- Oxygen uptake
Author Disclosures: V.H. Kumar: None. S.F. Gugino: None. C. Koenigsknecht: None. P. Chandrashekeran: None. J. Helman: None. S. Lakshminrusimha: None.
- © 2016 by American Heart Association, Inc.