Antithrombin administration during experimental cardiopulmonary resuscitation.
OBJECTIVE
To determine whether antithrombin (AT) administration during cardiopulmonary resuscitation (CPR) increased cerebral circulation and reduced reperfusion injury.


METHODS
Ventricular fibrillation was induced in 24 anaesthetised pigs. After a 5-min non-intervention interval, CPR was started. The animals were randomised into two groups. The treatment group received AT (250 U/kg) and the control group received placebo, after 7 min of CPR. Defibrillation was attempted after 9 min of CPR. If restoration of spontaneous circulation (ROSC) was achieved, the animals were observed for 4 h. Cortical cerebral blood flow was measured using laser-Doppler flowmetry. Cerebral oxygen extraction was calculated to reflect the relation between global cerebral circulation and oxygen demand. Measurements of eicosanoids (8-iso-PGF(2alpha) and 15-keto-dihydro-PGF(2alpha)), AT, thrombin-antithrombin complex (TAT) and soluble fibrin in jugular bulb plasma were performed to detect any signs of cerebral oxidative injury, inflammation and coagulation.


RESULTS
There was no difference between the groups in cortical cerebral blood flow, cerebral oxygen extraction, or levels of eicosanoids, TAT or soluble fibrin in jugular bulb plasma after ROSC. In the control group reduction of AT began 15 min after ROSC and continued throughout the entire observation period (P < 0.05). Eicosanoids and TAT were increased compared to baseline in all animals (P < 0.01).


CONCLUSIONS
In this experimental model of CPR, AT administration did not increase cerebral circulation or reduce reperfusion injury after ROSC.
Johansson
Jakob
J
Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University Hospital, Uppsala S-751 85, Sweden. jakob.johansson@surgsci.uu.se
Ridefelt
Peter
P
Basu
Samar
S
Rubertsson
Sten
S
D000818:Animals; D000990:Antithrombin III; D000991:Antithrombins / Q000627:therapeutic use*; D001921:Brain / Q000378:metabolism; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D015237:Dinoprost / Q000031:analogs & derivatives* / Q000097:blood; D005337:Fibrin / Q000032:analysis; D006323:Heart Arrest / Q000628:therapy*; D017078:Laser-Doppler Flowmetry; D010101:Oxygen Consumption; D010447:Peptide Hydrolases / Q000097:blood; D015427:Reperfusion Injury / Q000517:prevention & control; D013552:Swine; D013997:Time Factors; D014693:Ventricular Fibrillation
D000991:Antithrombins; C046193:antithrombin III-protease complex; C075750:8-epi-prostaglandin F2alpha; C026528:15-ketoprostaglandin F2alpha; D000990:Antithrombin III; D005337:Fibrin; D015237:Dinoprost; D010447:Peptide Hydrolases