High-dose erythropoietin during cardiac resuscitation lessens postresuscitation myocardial stunning in swine

Borovnik-Lesjak, Vesna; Whitehouse, Kasen; Baetiong, Alvin; Artin, Bassel; Radhakrishnan, Jeejabai; Gazmuri, Raúl J.

doi:10.1016/j.trsl.2013.06.002

Cited by 17 publications

(16 citation statements)

References 47 publications

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“…Sample sizes of 12 pigs per group were deemed adequate to detect statistically significant differences at an a level 0.05 and power 0.80 for the main effects based on previous studies by us using swine models of cardiac arrest. 37,38 For example, to detect a 120-minute difference with a SD of 90 minutes in survival among the 3 groups, 12 animals per group would be required at an a level 0.05 and power 0.80. The data are reported in the text as proportions, meanAESD, or median with the corresponding first and third quartiles (Q1-Q3) and as specified in the Table and in figures 5 to 8.…”

Section: Discussionmentioning

confidence: 99%

Real‐Time Ventricular Fibrillation Amplitude‐Spectral Area Analysis to Guide Timing of Shock Delivery Improves Defibrillation Efficacy During Cardiopulmonary Resuscitation in Swine

Aiello

Perez

Cogan

et al. 2017

JAHA

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BackgroundThe ventricular fibrillation amplitude spectral area (AMSA) predicts whether an electrical shock could terminate ventricular fibrillation and prompt return of spontaneous circulation. We hypothesized that AMSA can guide more precise timing for effective shock delivery during cardiopulmonary resuscitation.Methods and ResultsThree shock delivery protocols were compared in 12 pigs each after electrically induced ventricular fibrillation, with the duration of untreated ventricular fibrillation evenly stratified into 6, 9, and 12 minutes: AMSA‐Driven (AD), guided by an AMSA algorithm; Guidelines‐Driven (GD), according to cardiopulmonary resuscitation guidelines; and Guidelines‐Driven/AMSA‐Enabled (GDAE), as per GD but allowing earlier shocks upon exceeding an AMSA threshold. Shocks delivered using the AD, GD, and GDAE protocols were 21, 40, and 62, with GDAE delivering only 2 AMSA‐enabled shocks. The corresponding 240‐minute survival was 8/12, 6/12, and 2/12 (log‐rank test, P=0.035) with AD exceeding GDAE (P=0.026). The time to first shock (seconds) was (median [Q1–Q3]) 272 (161–356), 124 (124–125), and 125 (124–125) (P<0.001) with AD exceeding GD and GDAE (P<0.05); the average coronary perfusion pressure before first shock (mm Hg) was 16 (9–30), 10 (6–12), and 3 (−1 to 9) (P=0.002) with AD exceeding GDAE (P<0.05); and AMSA preceding the first shock (mV·Hz, mean±SD) was 13.3±2.2, 9.0±1.6, and 8.6±2.0 (P<0.001) with AD exceeding GD and GDAE (P<0.001). The AD protocol delivered fewer unsuccessful shocks (ie, less shock burden) yielding less postresuscitation myocardial dysfunction and higher 240‐minute survival.ConclusionsThe AD protocol improved the time precision for shock delivery, resulting in less shock burden and less postresuscitation myocardial dysfunction, potentially improving survival compared with time‐fixed, guidelines‐driven, shock delivery protocols.

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Section: Discussionmentioning

confidence: 99%

Real‐Time Ventricular Fibrillation Amplitude‐Spectral Area Analysis to Guide Timing of Shock Delivery Improves Defibrillation Efficacy During Cardiopulmonary Resuscitation in Swine

Aiello

Perez

Cogan

et al. 2017

JAHA

Self Cite

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“…trauma patients [20]. Furthermore, it has been demonstrated that EPO administration improves myocardial dysfunction [21,22], hemodynamic variables, and survival rates in animal model of cardiac arrest [23,24]. In addition, one clinical study suggests that EPO facilitates the return of spontaneous circulation and survival in victims of out-ofhospital cardiac arrest [25].…”

Section: Discussionmentioning

confidence: 99%

Erythropoietin Pretreatment Attenuates Seawater Aspiration-Induced Acute Lung Injury in Rats

Tong

Tan

et al. 2015

Inflammation

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Seawater drowning-induced acute lung injury (ALI) is a serious clinical condition characterized by increased alveolar-capillary permeability, excessive inflammatory responses, and refractory hypoxemia. However, current therapeutic options are largely supportive; thus, it is of great interest to search for alternative agents to treat seawater aspiration-induced ALI. Erythropoietin (EPO) is a multifunctional agent with antiinflammatory, antioxidative, and antiapoptotic properties. However, the effects of EPO on seawater aspiration-induced ALI remain unclear. In the present study, male rats were randomly assigned to the naive group, normal saline group, seawater group, or seawater + EPO group. EPO was administered intraperitoneally at 48 and 24 h before seawater aspiration. Arterial blood gas analysis was performed with a gas analyzer at baseline, 30 min, 1 h, 4 h, and 24 h after seawater aspiration, respectively. Histological scores, computed tomography scan, nuclear factor kappa B p65, inducible nitric oxide synthase, caspase-3, tumor necrosis factor-alpha, interleukin (IL)-1β, IL-6, IL-10, wet-to-dry weight ratio, myeloperoxidase activity, malondialdehyde, and superoxide dismutase in the lung were determined 30 min after seawater aspiration. Our results showed that EPO pretreatment alleviated seawater aspiration-induced ALI, as indicated by increased arterial partial oxygen tension and decreased lung histological scores. Furthermore, EPO pretreatment attenuated seawater aspiration-induced increase in the expressions of pulmonary nuclear factor kappa B p65, inducible nitric oxide synthase, caspase-3, tumor necrosis factor-alpha, IL-1β, myeloperoxidase activity, and malondialdehyde when compared with the seawater group. Collectively, our study suggested that EPO pretreatment attenuates seawater aspiration-induced ALI by down-regulation of pulmonary pro-inflammatory cytokines, oxidative stress, and apoptosis.

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“…Similarly, Grmec et al reported that EPO administered intravenously within the first 2 minutes of CPR after out-of-hospital cardiac arrest facilitates ROSC, intensive care unit admission, 24-hour survival, and hospital survival [25]. Early ROSC decreases the severity of postcardiac arrest myocardial stunning and promotes postresuscitation hemodynamic stability, which may improve renal perfusion and function [26]. …”

Section: Discussionmentioning

confidence: 99%

Effect of Erythropoietin on Postresuscitation Renal Function in a Swine Model of Ventricular Fibrillation

Pantazopoulos

Iacovidou

Kouskouni

et al. 2016

BioMed Research International

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Purpose. To investigate the effect of EPO administration on postresuscitation renal function. Methods. Twenty-four female Landrace/Large-White piglets aged 10–15 weeks with average weight of 19 ± 2 kg were randomly assigned to 2 different groups of 12 subjects each. After the end of an 8-minute ventricular fibrillation, the control group (Group C) received saline as placebo, whereas the EPO group (Group E) received EPO 5000 U/kg. The animals were resuscitated according to the 2010 European Resuscitation Council Guidelines for Resuscitation. Results. Five animals (41.67%) from Group C and 11 animals (91.67%) from Group E achieved ROSC (p = 0.027). Eight animals (66.67%, 5 surviving and 3 nonsurviving) from Group C suffered severe kidney damage or AKI compared to animals from Group E, in which none of the swine had evidence of severe kidney damage or AKI (p = 0.001). There was a statistically significant difference in all tested biochemical markers between the two groups, as well as a positive correlation of creatinine with NGAL, L-FABP, and IL-18 (summed mean values' p = 0.049, 0.01, and 0.004, resp.). Conclusions. Administration of EPO protected swine from postresuscitation acute kidney injury.

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High-dose erythropoietin during cardiac resuscitation lessens postresuscitation myocardial stunning in swine

Cited by 17 publications

References 47 publications

Real‐Time Ventricular Fibrillation Amplitude‐Spectral Area Analysis to Guide Timing of Shock Delivery Improves Defibrillation Efficacy During Cardiopulmonary Resuscitation in Swine

Real‐Time Ventricular Fibrillation Amplitude‐Spectral Area Analysis to Guide Timing of Shock Delivery Improves Defibrillation Efficacy During Cardiopulmonary Resuscitation in Swine

Erythropoietin Pretreatment Attenuates Seawater Aspiration-Induced Acute Lung Injury in Rats

Effect of Erythropoietin on Postresuscitation Renal Function in a Swine Model of Ventricular Fibrillation

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