title: Evaluation of remote ischaemic post-conditioning in a pig model of cardiac arrest: A pilot study.
abstract: BACKGROUND
  Remote ischaemic post-conditioning (RIPoC) in which transient episodes of ischaemia (e.g. by inflation and deflation of a blood pressure cuff) are applied after a prolonged ischaemia/reperfusion injury, may have the potential to improve patient outcome and survival following cardiac arrest. In this study we employed a pig model of cardiac arrest and successful cardiopulmonary resuscitation to evaluate the effects of RIPoC on haemodynamics, cardiac tissue damage and neurologic deficit.
  
  
  METHODS
  A total of 22 pigs were subjected to ventricular fibrillation, cardiopulmonary resuscitation and randomly assigned to Control or RIPoC treatment consisting of 4 cycles of 5 min femoral artery occlusion followed by 5 min of reperfusion starting 10min after return of spontaneous circulation (ROSC). Post-resuscitation was evaluated by haemodynamics using left ventricular conductance catheters, quantification of cardiac troponin T (cTnT), lactate dehydrogenase (LDH) and creatine kinase (CK). Neurological testing was performed 24h after return of spontaneous circulation (ROSC).
  
  
  RESULTS
  RIPoC resulted in a statistically significant reduction of serum cTnT levels 4h after ROSC (P ≤ 0.01). LDH and CK concentrations were significantly lower in RIPoC treated pigs 24h after ROSC (P ≤ 0.001), suggesting tissue and/or cardioprotective effects of RIPoC. End-systolic pressure volume relationship was significantly increased in RIPoC treated animals 4h after ROSC (P ≤ 0.05). Neurological testing revealed a trend towards an improved outcome in RIPoC treated animals.
  
  
  CONCLUSIONS
  We propose that RIPoC applied immediately after ROSC reduces serum concentrations of markers for cell damage and improves end-systolic pressure volume relationship 4h after ROSC.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Albrecht
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Broch
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Karina
authors.initials: K
authors.lastname: Zitta
authors.affiliation: Department of Anaesthesiology, University Hospital RTWH Aachen, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Hein
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Jan-Thorsten
authors.initials: JT
authors.lastname: Gräsner
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Renner
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany. Electronic address: matthias.gruenewald@uksh.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gruenewald
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006439:Hemodynamics; D057775:Ischemic Postconditioning / Q000379:methods*; D008955:Models, Cardiovascular; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D009206:Myocardium / Q000378:metabolism*; D009460:Neurologic Examination / Q000379:methods; D010101:Oxygen Consumption; D010865:Pilot Projects; D013552:Swine; D020107:Troponin T / Q000097:blood; D014693:Ventricular Fibrillation / Q000150:complications
chemical_list: D020107:Troponin T
keywords: Cardiac arrest; Left ventricular function; Neurological function; Post conditioning; Resuscitation