Esmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest

Abstract 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....

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Autores principales:	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, Giovanni Babini, Lidia Staszewsky, Davide Zani, Davide Pravettoni, Angelo Belloli, Eugenio Scanziani, Roberto Latini, Aurora Magliocca
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5f849f22a1b343d8bc393d3e5e1dc97a
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spelling	oai:doaj.org-article:5f849f22a1b343d8bc393d3e5e1dc97a2021-12-02T14:59:06ZEsmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest10.1038/s41598-021-90202-w2045-2322https://doaj.org/article/5f849f22a1b343d8bc393d3e5e1dc97a2021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-90202-whttps://doaj.org/toc/2045-2322Abstract 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. 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 induced in 16 pigs and left untreated for 12 min. During CPR, animals were randomized to receive epinephrine (30 µg/kg) with either esmolol (0.5 mg/kg) or saline (control). Pigs were then observed up to 96 h. Coronary perfusion pressure increased during CPR in the esmolol group compared to control (47 ± 21 vs. 24 ± 10 mmHg at min 5, p < 0.05). In both groups, 7 animals were successfully resuscitated and 4 survived up to 96 h. 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 (score 0.3 ± 0.5 vs. 1.3 ± 0.5, p < 0.05) and hippocampal microglial activation (6 ± 3 vs. 22 ± 4%, 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 (2[1–3] vs. 21[16–52] ng/mL, p < 0.01). In this preclinical model, β1-blockade during CPR did not facilitate VF termination but provided neuroprotection.Laura RuggeriFrancesca NespoliGiuseppe RistagnoFrancesca FumagalliAntonio BoccardoDavide OlivariRoberta AffatatoDeborah NovelliDaria De GiorgioPierpaolo RomanelliLucia MinoliAlberto CucinoGiovanni BabiniLidia StaszewskyDavide ZaniDavide PravettoniAngelo BelloliEugenio ScanzianiRoberto LatiniAurora MaglioccaNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q 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 Giovanni Babini Lidia Staszewsky Davide Zani Davide Pravettoni Angelo Belloli Eugenio Scanziani Roberto Latini Aurora Magliocca Esmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest
description	Abstract 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. 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 induced in 16 pigs and left untreated for 12 min. During CPR, animals were randomized to receive epinephrine (30 µg/kg) with either esmolol (0.5 mg/kg) or saline (control). Pigs were then observed up to 96 h. Coronary perfusion pressure increased during CPR in the esmolol group compared to control (47 ± 21 vs. 24 ± 10 mmHg at min 5, p < 0.05). In both groups, 7 animals were successfully resuscitated and 4 survived up to 96 h. 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 (score 0.3 ± 0.5 vs. 1.3 ± 0.5, p < 0.05) and hippocampal microglial activation (6 ± 3 vs. 22 ± 4%, 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 (2[1–3] vs. 21[16–52] ng/mL, p < 0.01). In this preclinical model, β1-blockade during CPR did not facilitate VF termination but provided neuroprotection.
format	article
author	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 Giovanni Babini Lidia Staszewsky Davide Zani Davide Pravettoni Angelo Belloli Eugenio Scanziani Roberto Latini Aurora Magliocca
author_facet	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 Giovanni Babini Lidia Staszewsky Davide Zani Davide Pravettoni Angelo Belloli Eugenio Scanziani Roberto Latini Aurora Magliocca
author_sort	Laura Ruggeri
title	Esmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest
title_short	Esmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest
title_full	Esmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest
title_fullStr	Esmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest
title_full_unstemmed	Esmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest
title_sort	esmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/5f849f22a1b343d8bc393d3e5e1dc97a
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Esmolol during cardiopulmonary resuscitation reduces neurological injury in a porcine model of cardiac arrest

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