A randomized and blinded trial of inhaled nitric oxide in a piglet model of pediatric cardiopulmonary resuscitation

RESUSCITATION

卷:162

Article

Morgan, Ryan W.^1,2  Sutton, Robert M.^1,2  Himebauch, Adam S.^1,2  Roberts, Anna L.¹  Landis, William P.¹  Lin, Yuxi¹  Starr, Jonathan¹  Ranganathan, Abhay¹  Delso, Nile¹  Mavroudis, Constantine D.³  Volk, Lindsay³  Slovis, Julia¹  Marquez, Alexandra M.¹  Nadkarni, Vinay M.^1,2  Hefti, Marco⁴  Berg, Robert A.^1,2  Kilbaugh, Todd J.^1,2 

[1] Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, Philadelphia, PA 19104 USA

[2] Univ Penn, Dept Anesthesiol & Crit Care Med, Perelman Sch Med, Philadelphia, PA USA

[3] Childrens Hosp Philadelphia, Dept Surg, Div Cardiothorac Surg, Philadelphia, PA 19104 USA

[4] Univ Iowa, Dept Pathol, Carver Coll Med, Iowa City, IA 52242 USA

关键词: In-hospital cardiac arrest;    Cardiopulmonary resuscitation;    Pediatrics;    Shock;    Pulmonary hypertension;    Inhaled nitric oxide;    Physiology;    Cerebral blood flow;    Hemodynamics;    Laboratory;   

DOI  :  10.1016/j.resuscitation.2021.03.004

来源: Elsevier

【 摘 要 】

Aim: Inhaled nitric oxide (iNO) during cardiopulmonary resuscitation (CPR) improved systemic hemodynamics and outcomes in a preclinical model of adult in-hospital cardiac arrest (IHCA) and may also have a neuroprotective role following cardiac arrest. The primary objectives of this study were to determine if iNO during CPR would improve cerebral hemodynamics and mitochondrial function in a pediatric model of lipopolysaccharide-induced shock-associated IHCA. Methods: After lipopolysaccharide infusion and ventricular fibrillation induction, 20 1-month-old piglets received hemodynamic-directed CPR and were randomized to blinded treatment with or without iNO (80 ppm) during and after CPR. Defibrillation attempts began at 10 min with a 20-min maximum CPR duration. Cerebral tissue from animals surviving 1-h post-arrest underwent high-resolution respirometry to evaluate the mitochondrial electron transport system and immunohistochemical analyses to assess neuropathology. Results: During CPR, the iNO group had higher mean aortic pressure (41.6 +/- 2.0 vs. 36.0 +/- 1.4 mmHg; p = 0.005); diastolic BP (32.4 +/- 2.4 vs. 27.1 +/- 1.7 mmHg; p = 0.03); cerebral perfusion pressure (25.0 +/- 2.6 vs. 19.1 +/- 1.8 mmHg; p = 0.02); and cerebral blood flow relative to baseline (rCBF: 243.2 +/- 54.1 vs. 115.5 +/- 37.2%; p = 0.02). Among the 8/10 survivors in each group, the iNO group had higher mitochondrial Complex I oxidative phosphorylation in the cerebral cortex (3.60 [3.56, 3.99] vs. 3.23 [2.44, 3.46] pmol O-2/s mg; p = 0.01) and hippocampus (4.79 [4.35, 5.18] vs. 3.17 [2.75, 4.58] pmol O-2/s mg; p = 0.02). There were no other differences in mitochondrial respiration or brain injury between groups. Conclusions: Treatment with iNO during CPR resulted in superior systemic hemodynamics, rCBF, and cerebral mitochondrial Complex I respiration in this pediatric cardiac arrest model.

【 授权许可】

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