title: Microdialysis Assessment of Cerebral Perfusion during Cardiac Arrest, Extracorporeal Life Support and Cardiopulmonary Resuscitation in Rats - A Pilot Trial.
abstract: Cerebral metabolic alterations during cardiac arrest, cardiopulmonary resuscitation (CPR) and extracorporeal cardiopulmonary life support (ECLS) are poorly explored. Markers are needed for a more personalized resuscitation and post-resuscitation care. Aim of this study was to investigate early metabolic changes in the hippocampal CA1 region during ventricular fibrillation cardiac arrest (VF-CA) and ECLS versus conventional CPR. Male Sprague-Dawley rats (350g) underwent 8min untreated VF-CA followed by ECLS (n = 8; bloodflow 100ml/kg), mechanical CPR (n = 18; 200/min) until return of spontaneous circulation (ROSC). Shams (n = 2) were included. Glucose, glutamate and lactate/pyruvate ratio were compared between treatment groups and animals with and without ROSC. Ten animals (39%) achieved ROSC (ECLS 5/8 vs. CPR 5/18; OR 4,3;CI:0.7-25;p = 0.189). During VF-CA central nervous glucose decreased (0.32±0.1mmol/l to 0.04±0.01mmol/l; p<0.001) and showed a significant rise (0.53±0.1;p<0.001) after resuscitation. Lactate/pyruvate (L/P) ratio showed a 5fold increase (31 to 164; p<0.001; maximum 8min post ROSC). Glutamate showed a 3.5-fold increase to (2.06±1.5 to 7.12±5.1μmol/L; p<0.001) after CA. All parameters normalized after ROSC with no significant differences between ECLS and CPR. Metabolic changes during ischemia and resuscitation can be displayed by cerebral microdialysis in our VF-CA CPR and ECLS rat model. We found similar microdialysate concentrations and patterns of normalization in both resuscitation methods used. Institutional Protocol Number: GZ0064.11/3b/2011.
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schober
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Warenits
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Testori
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weihs
authors.affiliation: Department of Neurosurgery, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Arthur
authors.initials: A
authors.lastname: Hosmann
authors.affiliation: Department of Pathobiology, University of Veterinary Medicine of Vienna, Veterinärplatz 1, 1210 Vienna, Austria.
authors.forename: Sandra
authors.initials: S
authors.lastname: Högler
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Janata
authors.affiliation: Department of Internal Medicine III, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Scherer
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Ingrid A M
authors.initials: IA
authors.lastname: Magnet
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Ettl
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Anton N
authors.initials: AN
authors.lastname: Laggner
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Herkner
authors.affiliation: Department of Clinical Pharmacology, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Zeitlinger
mesh_terms: D000818:Animals; D015415:Biomarkers; D001794:Blood Pressure; D056547:CA1 Region, Hippocampal / Q000378:metabolism; D016887:Cardiopulmonary Resuscitation; D002540:Cerebral Cortex / Q000098:blood supply* / Q000378:metabolism; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005947:Glucose / Q000378:metabolism; D018698:Glutamic Acid / Q000378:metabolism; D006323:Heart Arrest / Q000175:diagnosis* / Q000628:therapy; D006439:Hemodynamics; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D017551:Microdialysis / Q000379:methods; D010100:Oxygen / Q000097:blood / Q000378:metabolism; D010477:Perfusion; D019289:Pyruvic Acid / Q000378:metabolism; D051381:Rats
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D018698:Glutamic Acid; D019289:Pyruvic Acid; D005947:Glucose; D010100:Oxygen