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CRITICAL CARE AND TRAUMA

Hypertonic-Hyperoncotic Solutions Reduce the Release of Cardiac Troponin I and S-100 After Successful Cardiopulmonary Resuscitation in Pigs

Heiner Krieter, MD DEAA^*, Christof Denz, MD^*, Christoph Janke, MD^*, Thomas Bertsch, MD, Thomas Luiz, MD^*, Klaus Ellinger, MD^*, and Klaus van Ackern, MD^*

Institutes of *Anesthesiology and Intensive Care Medicine and Clinical Chemistry, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany

Address correspondence and reprint requests to Heiner Krieter, MD, DEAA, Postfach 10 19 42, 68019 Mannheim, Germany. Address e-mail to heiner.krieter{at}anaes.ma.uni-heidelberg.de

In some patients, cardiopulmonary resuscitation (CPR) can revive spontaneous circulation (ROSC). However, neurological outcome often remains poor. Hypertonic-hyperoncotic solutions (HHS) have been shown to improve microvascular conductivity after regional and global ischemia. We investigated the effect of infusion of HHS in a porcine CPR model. Cardiac arrest was induced by ventricular fibrillation. Advanced cardiac life support was begun after 4 min of nonintervention and 1 min of basic life support. Upon ROSC, the animals randomly received 125 mL of either normal saline (placebo, n = 8) or 7.2% NaCl and 10% hydroxyethyl starch 200,000/0.5 (HHS, n = 7). Myocardial and cerebral damage were assessed by serum concentrations of cardiac troponin I and astroglial protein S-100, respectively, up to 240 min after ROSC. In all animals, the levels of cardiac troponin I and S-100 increased after ROSC (P < 0.01). This increase was significantly blunted in animals that received HHS instead of placebo. The use of HHS in the setting of CPR may provide a new option in reducing cell damage in postischemic myocardial and cerebral tissues.

IMPLICATIONS: Infusion of hypertonic-hyperoncotic solutions (HHS) after successful cardiopulmonary resuscitation in pigs significantly reduced the release of cardiac troponin I and cerebral protein S-100, which are sensitive and specific markers of cell damage. Treatment with HHS may provide a new option to improve the outcome of cardiopulmonary resuscitation.

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