Intralipid infusion diminishes return of spontaneous circulation after hypoxic cardiac arrest in rabbits.
BACKGROUND
Infusion of lipid emulsion has been shown to reverse lipophilic drug-induced cardiovascular collapse in laboratory models and humans. The effect of high dose lipid in nondrug-induced cardiac arrest is, however, uncertain. In a rabbit model of asphyxial pulseless electrical activity (PEA) we compared lipid augmented with standard advanced cardiac life support (ACLS) resuscitation.


METHODS
Adult New Zealand White rabbits underwent hypoxic PEA via tracheal clamping. After 2 min of cardiac arrest, basic life support cardiopulmonary resuscitation was commenced and 3 mL/kg 20% Intralipid or 3 mL/kg 0.9% saline solution infused. Adrenaline (100 microg/kg) was administered at 4 and 5 min. Return of spontaneous circulation (ROSC), hemodynamic metrics, and survival to 50 min were recorded.


RESULTS
Seven of 11 saline-treated rabbits developed ROSC versus 1 of 12 Intralipid-treated animals; P = 0.009. No significant difference in survival to 50 min was observed (3/11 saline vs 0/12 Intralipid; P = 0.211).


CONCLUSIONS
In this model of hypoxia-induced PEA, standard ACLS resulted in greater coronary perfusion pressure and increased ROSC compared with ACLS plus lipid infusion. Lipid emulsion may be contraindicated in cardiac arrest complicated by significant hypoxia.
Harvey
Martyn
M
Department of Emergency Medicine, Waikato Hospital, Pembroke Street, Hamilton, New Zealand. harveym@waikatodhb.govt.nz
Cave
Grant
G
Kazemi
Alex
A
D000818:Animals; D001237:Asphyxia / Q000150:complications / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects*; D016887:Cardiopulmonary Resuscitation; D002316:Cardiotonic Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003326:Coronary Circulation / Q000187:drug effects*; D004195:Disease Models, Animal; D004837:Epinephrine / Q000008:administration & dosage; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D011817:Rabbits; D013997:Time Factors
D002316:Cardiotonic Agents; D005217:Fat Emulsions, Intravenous; D004837:Epinephrine