title: Adenosine, lidocaine, and Mg2+ (ALM™) increases survival and corrects coagulopathy after eight-minute asphyxial cardiac arrest in the rat.
abstract: BACKGROUND
  No drug therapy has demonstrated improved survival following cardiac arrest (CA) of cardiac or noncardiac origin. In an effort to translate the cardiorescue properties of Adenocaine (adenosine and lidocaine) and magnesium sulfate (ALM) from cardiac surgery and hemorrhagic shock to resuscitation, we examined the effect of ALM on hemodynamic rescue and coagulopathy following asphyxial-induced CA in the rat.
  
  
  METHODS
  Nonheparinized animals (400-500 g, n = 39) were randomly assigned to 0.9% saline (n = 12) and 0.9% saline ALM (n = 10) groups. After baseline data were acquired, the animal was surface cooled (33°C-34°C) and the ventilator line clamped for 8 min inducing CA; 0.5 mL of solution was injected intravenously followed by 60-s chest compressions (300/min), and rats were rewarmed. Return of spontaneous circulation (ROSC), mean arterial pressure, heart rate, and rectal temperature were recorded for 2 h. Additional rats were randomized for rotation thromboelastometry measurements (n = 17).
  
  
  RESULTS
  Rats treated with ALM had a significant survival benefit (100% ALM vs. 67% controls achieved ROSC) and generated a higher mean arterial pressure than did controls after 75 min (81 vs. 72 mmHg at 120 min, P < 0.05). In all rats, rotation thromboelastometry lysis index decreased during CA, implying hyperfibrinolysis. Control ROSC survivors displayed hypocoagulopathy (prolonged EXTEM/INTEM clotting time, clot formation time, prothrombin time, activated partial thromboplastin time), decreased maximal clot firmness, lowered elasticity, and lowered clot amplitudes but no change in lysis index. These coagulation abnormalities were corrected by ALM at 120 min after ROSC.
  
  
  CONCLUSIONS
  Small bolus of 0.9% NaCl ALM improved survival and hemodynamics following nonhemorrhagic, asphyxial CA and corrected prolonged clot times and clot retraction compared with controls.
authors.affiliation: Heart and Trauma Research Laboratory, Physiology and Pharmacology, James Cook University, Queensland, Australia.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Djabir
authors.forename: Hayley L
authors.initials: HL
authors.lastname: Letson
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Dobson
mesh_terms: D000241:Adenosine / Q000627:therapeutic use*; D000818:Animals; D001237:Asphyxia / Q000188:drug therapy*; D006323:Heart Arrest / Q000188:drug therapy*; D008012:Lidocaine / Q000627:therapeutic use*; D008274:Magnesium / Q000627:therapeutic use*; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley
chemical_list: D008012:Lidocaine; D008274:Magnesium; D000241:Adenosine