Esmolol during Cardiopulmonary Resuscitation Reduces Neurological Injury in a Porcine Model of Cardiac Arrest [post]

Laura Ruggeri, Francesca Nespoli, Giuseppe Ristagno, Francesca Fumagalli, Antonio Boccardo, Davide Olivari, Roberta Affatato, Deborah Novelli, Daria De Giorgio, Pierpaolo Romanelli, Lucia Minoli, Alberto Cucino (+8 others)
2021 unpublished
Background. Primary vasopressor efficacy of epinephrine during cardiopulmonary resuscitation (CPR) is due to its α-adrenergic effects. However, epinephrine plays β1-adrenergic actions, which increasing myocardial oxygen consumption may lead to refractory ventricular fibrillation (VF) and poor outcome. Methods. Effects of a single dose of esmolol in addition to epinephrine during CPR were investigated in a porcine model of VF with an underlying acute myocardial infarction. VF was ischemically
more » ... uced in 36 pigs and left untreated for 12min. During CPR, animals were randomized to receive epinephrine (30µg/kg) with either esmolol (0.5mg/kg) or saline (control). Pigs were then observed up to 96h. Results. Coronary perfusion pressure increased during CPR in the esmolol group compared to control (p<0.05). In both groups, 7 animals were successfully resuscitated and 4 survived up to 96h. No significant differences were observed between groups in the total number of defibrillations delivered prior to final resuscitation. Brain histology demonstrated reductions in cortical neuronal degeneration/necrosis (p<0.05) and hippocampal microglial activation (p<0.01) in the esmolol group compared to control. Lower circulating levels of neuron specific enolase were measured in esmolol animals compared to controls (p<0.01). Conclusions. In this preclinical model, β1-blockade during CPR did not facilitate VF termination but provided neuroprotection.
doi:10.21203/ fatcat:vv5pin3eonexvbpzj6bd4rpxpu