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ANESTHETIC PHARMACOLOGY

Intralipid Infusion Diminishes Return of Spontaneous Circulation After Hypoxic Cardiac Arrest in Rabbits

Martyn Harvey, FACEM^*, Grant Cave, FACEM, and Alex Kazemi, MBChB

From the *Department of Emergency Medicine, Waikato Hospital, Hamilton, New Zealand; Department of Surgery and Anaesthesia, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand and Department of Emergency Medicine, Hutt Hospital, Lower Hutt, New Zealand; and Department of Intensive Care, Middlemore Hospital, Auckland, New Zealand.

Address correspondence and reprint requests to Dr. Martyn Harvey, Department of Emergency Medicine, Waikato Hospital, Pembroke Street, Hamilton, New Zealand. Address e-mail to harveym{at}waikatodhb.govt.nz.

BACKGROUND: Infusion of lipid emulsion has been shown to reverse lipophilic drug-induced cardiovascular collapse in laboratory models and humans. The effect of high dose lipid in nondrug-induced cardiac arrest is, however, uncertain. In a rabbit model of asphyxial pulseless electrical activity (PEA) we compared lipid augmented with standard advanced cardiac life support (ACLS) resuscitation.

METHOD: Adult New Zealand White rabbits underwent hypoxic PEA via tracheal clamping. After 2 min of cardiac arrest, basic life support cardiopulmonary resuscitation was commenced and 3 mL/kg 20% Intralipid or 3 mL/kg 0.9% saline solution infused. Adrenaline (100 µg/kg) was administered at 4 and 5 min. Return of spontaneous circulation (ROSC), hemodynamic metrics, and survival to 50 min were recorded.

RESULTS: Seven of 11 saline-treated rabbits developed ROSC versus 1 of 12 Intralipid-treated animals; P = 0.009. No significant difference in survival to 50 min was observed (3/11 saline vs 0/12 Intralipid; P = 0.211).

CONCLUSION: In this model of hypoxia-induced PEA, standard ACLS resulted in greater coronary perfusion pressure and increased ROSC compared with ACLS plus lipid infusion. Lipid emulsion may be contraindicated in cardiac arrest complicated by significant hypoxia.

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