Cariporide minimizes adverse myocardial effects of epinephrine during resuscitation from ventricular fibrillation*
| Autor: | Julieta D Kolarova, Robert D. Sanders, Iyad M. Ayoub, Ronald L. Kantola, Raúl J. Gazmuri |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
medicine.medical_specialty
Resuscitation Cariporide business.industry medicine.medical_treatment Return of spontaneous circulation Critical Care and Intensive Care Medicine medicine.disease chemistry.chemical_compound Epinephrine chemistry Internal medicine Intensive care Anesthesia Ventricular fibrillation Cardiology Coronary perfusion pressure Medicine Cardiopulmonary resuscitation business medicine.drug |
| Zdroj: | Critical Care Medicine. 33:2599-2605 |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/01.ccm.0000186773.88576.83 |
| Popis: | OBJECTIVE Epinephrine given during closed-chest resuscitation increases blood flow across the coronary and cerebral circuits. However, epinephrine worsens reperfusion arrhythmias and intensifies postresuscitation myocardial dysfunction. We investigated whether cariporide-a selective sodium-hydrogen exchanger isoform-1 inhibitor-could ameliorate such adverse effects without diminishing its vasopressor actions. DESIGN Randomized animal study. SETTING University-based animal laboratory. SUBJECTS Twenty-four anesthetized male domestic pigs (29-43 kg). INTERVENTIONS Ventricular fibrillation was electrically induced and left untreated for 8 mins. Pigs were randomized to receive after 2 mins of chest compression a 3 mg/kg bolus of cariporide (n = 8), a 0.02 mg/kg bolus of epinephrine (n = 8), or a combination of cariporide and epinephrine (n = 8). Additional doses of epinephrine were given if the coronary perfusion pressure decreased below 15 mm Hg. Successfully resuscitated pigs were observed for 72 hrs. MEASUREMENTS AND MAIN RESULTS The averaged coronary perfusion pressure was higher in the epinephrine (34 +/- 11 mm Hg, p = .001) and cariporide/epinephrine (35 +/- 10 mm Hg, p < .001) groups compared with the cariporide group (15 +/- 6 mm Hg). All pigs in the epinephrine and cariporide/epinephrine groups but only six in the cariporide group were successfully resuscitated and survived 72 hrs. During the immediate postresuscitation period, four of eight pigs in the epinephrine group had episodes of recurrent ventricular fibrillation or pulseless ventricular tachycardia requiring additional electrical shocks (7.0 +/- 6.4) but none in the cariporide and cariporide/epinephrine groups (chi-square, p = .008). Myocardial dysfunction occurred early after return of spontaneous circulation but only in the epinephrine group. CONCLUSIONS The combined administration of cariporide and epinephrine prompted adequate pressor effects during chest compression and facilitated reestablishment of cardiac activity without episodes of recurrent ventricular fibrillation or transient myocardial dysfunction as with epinephrine alone. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|