title: Ischemic Postconditioning and Nitric Oxide Administration Failed to Confer Protective Effects in a Porcine Model of Extracorporeal Cardiopulmonary Resuscitation.
abstract: The protective effects of ischemic postconditioning (IPC) and nitric oxide (NO) administration have been demonstrated in several ischemic scenarios. However, current evidence regarding the effect of IPC and NO in extracorporeal cardiopulmonary resuscitation remains lacking. Fifteen female swine (body weight 45 kg) underwent veno-arterial extracorporeal membrane oxygenation (ECMO) implantation; cardiac arrest-ventricular fibrillation was induced by rapid ventricular pacing. After 20 min of cardiac arrest, blood flow was restored by increasing the ECMO flow rate to 4.5 L/min. The animals (five per group) were then randomly assigned to receive IPC (three cycles of 3 min ischemia and reperfusion), NO (80 ppm via oxygenator), or mild hypothermia (HT; 33.0°C). Cerebral oximetry and aortic blood pressure were monitored continuously. After 90 min of reperfusion, blood samples were drawn for the measurement of troponin I, myoglobin, creatine-phosphokinase, alanine aminotransferase, neuron-specific enolase, cystatin C, and reactive oxygen metabolite (ROM) levels. Significantly higher blood pressure and cerebral oxygen saturation values were observed in the HT group compared with the IPC and NO groups (P < 0.05). The levels of troponin I, myoglobin, creatine phosphokinase, and alanine aminotransferase were significantly lower in the HT group (P < 0.05); levels of neuron-specific enolase, cystatin C, and ROM were not significantly different. IPC and NO were comparable in all monitored parameters. The results of the present study indicate that IPC and NO administration are not superior interventions to HT for the maintenance of blood pressure, cerebral oxygenation, organ protection, and suppression of oxidative stress following extracorporeal cardiopulmonary resuscitation.
authors.affiliation: Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Hana
authors.initials: H
authors.lastname: Psotova
authors.affiliation: Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Ostadal
authors.affiliation: Department of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Mikulas
authors.initials: M
authors.lastname: Mlcek
authors.affiliation: Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kruger
authors.affiliation: Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Janotka
authors.affiliation: Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Vondrakova
authors.affiliation: Department of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Svoboda
authors.affiliation: Department of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Matej
authors.initials: M
authors.lastname: Hrachovina
authors.affiliation: Department of Clinical Biochemistry, Hematology, and Immunology, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Ludek
authors.initials: L
authors.lastname: Taborsky
authors.affiliation: Department of Nuclear Medicine, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Vlasta
authors.initials: V
authors.lastname: Dudkova
authors.affiliation: Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
authors.forename: Svitlana
authors.initials: S
authors.lastname: Strunina
authors.affiliation: Department of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Otomar
authors.initials: O
authors.lastname: Kittnar
authors.affiliation: Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Neuzil
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D001794:Blood Pressure; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003402:Creatine Kinase / Q000097:blood; D055316:Cystatin C / Q000097:blood; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D057775:Ischemic Postconditioning / Q000379:methods*; D009211:Myoglobin / Q000097:blood; D009569:Nitric Oxide / Q000627:therapeutic use*; D018384:Oxidative Stress; D010751:Phosphopyruvate Hydratase / Q000097:blood; D020011:Protective Agents / Q000627:therapeutic use*; D017382:Reactive Oxygen Species / Q000097:blood; D013552:Swine; D019210:Troponin I / Q000097:blood
chemical_list: D055316:Cystatin C; D009211:Myoglobin; D020011:Protective Agents; D017382:Reactive Oxygen Species; D019210:Troponin I; D009569:Nitric Oxide; D000410:Alanine Transaminase; D003402:Creatine Kinase; D010751:Phosphopyruvate Hydratase
keywords: Cardiac arrest; Cerebral oxygenation; Extracorporeal cardiopulmonary resuscitation; Hypothermia; Ischemic postconditioning; Nitric oxide; Organ protection