Estimation of myocardial ischemic injury during ventricular fibrillation with total circulatory arrest using high-energy phosphates and lactate as metabolic markers

doi:10.1016/S0196-0644(05)80927-8

Annals of Emergency Medicine

Volume 20, Issue 3, March 1991, Pages 222-229

https://doi.org/10.1016/S0196-0644(05)80927-8 Get rights and content

Study objective:

To define the time course of myocardial ischemic injury using high-energy phosphate (HEP) depletion and the cessation of lactate production as metabolic markers.

Setting:

Data were collected in a laboratory animal model.

Type of participants:

Ten immature mixed breed swine weighing 23.2 ± 3.5 kg.

Design:

After thoracotomy transmural myocardial biopsies were taken in vivo during normal sinus rhythm and at designated times during ventricular fibrillation with total circulatory arrest (VF-TCA).

Measurements and main results:

Frozen tissue samples were analyzed for adenine nucleotides, by high-performance liquid chromatography, and lactate by enzymatic assay. At five minutes of VF-TCA, myocardial adenosine triphosphate averaged 50% of control. At 15 minutes of VF-TCA, 89% of animals had myocardial adenosine triphosphate levels above 20% of control and adenylate charge ratio above 0.60. With more than 30 minutes of VF-TCA, all animals had adenosine triphosphate levels below 10% of control and adenylate charge ratio below 0.30. In addition, myocardial lactate levels plateaued after 30-minutes of VF-TCA, indicating the cessation of lactate production.

Conclusion:

These results suggest that the myocardium can tolerate VF-TCA for as long as 15 minutes without irreversible injury; however, postischemic myocardial dysfunction may occur after as little as five minutes of VF-TCA. With more than 30 minutes of VF-TCA, myocardial injury is likely to be irreversible.

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Of the 716 eligible patients, 422/716 (59%) had at least one chronic health condition; 21.8% with one, 19.6% with two, 10.3% with 3, and 7.3% with ≥4. Survival-to-discharge was 45% (324/716). In the multivariable model adjusted for traditional Utstein characteristics, increasing CCI was associated with lower odds of survival (Odds ratio (OR) (95% confidence interval] = 0.82 [0.72, 0.93] for each additional chronic health condition). The addition of AMSA to the model only modestly attenuated the CCI-survival association (OR = 0.85 [0.74,0.98]).
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: Presented at the Society for Academic Emergency Medicine Annual Meeting in San Diego, May 1989.

: Supported in part by grants from the Stanley J Sarnoff Foundation for Cardiovascular Science and the Eli Lilly Corporation/Emergency Medicine Foundation.

View full text

Estimation of myocardial ischemic injury during ventricular fibrillation with total circulatory arrest using high-energy phosphates and lactate as metabolic markers

Study objective:

Setting:

Type of participants:

Design:

Measurements and main results:

Conclusion:

Ann Emerg Med

Am J Emerg Med

J Mol Cell Cardiol

J Mol Cell Cardiol

J Mol Cell Cardiol

J Mol Cell Cardiol

J Mol Cell Cardiol

Am J Emerg Med

Am J Cardiol

Resuscitation

Analy Biochem

J Biol Chem

Am J Cardiol

J Surg Res

Am Heart J

Am Heart J

Am J Cardiol

J Am Coll Cardiol

J Thorac Cardiovasc Surg

Ann Emerg Med

Ann Emerg Med

Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation

Am J Public Health

The effect of direct mechanical ventricular assistance on myocardial hemodynamics during ventricular fibrillation

Crit Care Med

Reversibility limits for heart and brain of ventricular fibrillation cardiac arrest in dogs

Crit Care Med

Relation between high energy phosphate and lethal injury in myocardial ischemia in the dog

Am I Pathol

Effect of reperfusion late in the phase of reversible ischemic injury: Changes in cell volume, electrolytes, metabolytes, and ultrastructure

Circ Res