The effects of adenocaine (adenosine and lidocaine) on early post-resuscitation cardiac and neurological dysfunction in a porcine model of cardiac arrest

Granfeldt, Asger, Shi, WeiWei, Schmarkey, Susan L., Jiang, Rong, Bone, C. Collin, Cline, J. Mark, Wogensen, Lise, Dobson, Geoffrey P., Tønnesen, Else, and Vinten-Johansen, Jakob (2013) The effects of adenocaine (adenosine and lidocaine) on early post-resuscitation cardiac and neurological dysfunction in a porcine model of cardiac arrest. Resuscitation, 84 (11). pp. 1611-1618.

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Aim: Return of spontaneous circulation (ROSC) elicits ischaemia/reperfusion injury and myocardial dysfunction. The combination of adenosine and lidocaine (AL, adenocaine) has been shown to (1) inhibit neutrophil inflammatory activation and (2) improve left ventricular function after ischaemia. We hypothesized that resuscitation with adenocaine during early moments of cardiopulmonary resuscitation (CPR) attenuates leucocyte oxidant generation and myocardial dysfunction. Methods: Pigs were randomized to: (1) sham (n = 7), (2) cardiac arrest (CA; n = 16), or 3) cardiac arrest + adenocaine (CA + AL; n = 12). After 7 min of electrically induced ventricular fibrillation, start of CPR was followed by infusion of saline (CA) or adenocaine (CA + AL) for 6 min. Haemodynamics, cardiodynamics (pressure–volume loops) and leucocyte superoxide anion generation were assessed. Neurological function was evaluated after 24 h by histology and neurological deficit score (0 = normal; 500 = brain dead). Results: Rate of ROSC was comparable between groups: CA group 11/16 and CA + AL group 7/12 p = 0.57). Cardiac index transiently increased after ROSC in both groups. Left ventricular dysfunction demonstrated by a rightward shift of the intercept of end-systolic pressure–volume relations in CA was avoided in the CA + AL group. Leucocyte superoxide anion generation 2 h after ROSC was significantly attenuated in the CA + AL group compared to the CA group. Neurological deficit scores [CA: median: 17.5(IQR:0–75) and CA + AL: 35(IQR:15–150)] and histopathological damage were comparable in both groups (p = 0.37). Conclusion:Infusion of adenocaine during early resuscitation from CA significantly improved early post-resuscitation cardiac function and attenuated leucocyte superoxide anion generation, without a change in post-ROSC neurological function. (IACUC protocol number 023-2009).

Item ID: 31699
Item Type: Article (Research - C1)
ISSN: 1873-1570
Keywords: cardiac arrest, pig, myocardial dysfunction, adenosine, lidocaine, resuscitation
Funders: Tryg Foundation, The Beckett Foundation, Holger and Ruth Hesses Foundation, A.P. Moeller Foundation for the Advancement of Medical Science, Helga and Peter Kornings Foundation, The Danish Heart Foundation, Gocer Sven Hansen and wife Ina Hansens Foundation
Date Deposited: 26 Feb 2014 09:59
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 100%
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