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  • 1
    Language: English
    In: Resuscitation, January 2012, Vol.83(1), pp.113-118
    Description: Successful resuscitation after cardiac arrest is typically associated with cerebral and myocardial ischemia/reperfusion (I/R)-injury. Recently, we have demonstrated effects of therapeutic hypothermia (HT) and postconditioning with the volatile anesthetic sevoflurane (SEV) on I/R-mediated mechanisms in the heart and brain [Meybohm et al., PLoS One, 2009; Meybohm et al., Crit Care, 2010]. As the intestine is also highly susceptible to I/R-injury, we investigated the influence of HT and SEV on intestinal I/R-mediated events induced by cardiac arrest and successful resuscitation. Effects of I/R, HT (12 h, 33 °C) and a combination of HT with SEV (12 h, 2.0 vol%) were evaluated in a pig model of cardiac arrest and successful cardiopulmonary resuscitation. Western blotting, ELISA, caspase-3/7 assays, myeloperoxidase (MPO) quantifications and gelatine zymography were performed using intestinal tissue derived 24 h after return of spontaneous circulation. Compared to the normothermia control, HT and HT + SEV resulted in a significant increase in intestinal HIF-1α protein expression ( 〈 0.05). Tissue concentrations of IL-1β were significantly reduced in the HT and HT + SEV group ( 〈 0.05), whereas a reduction of IL-10 levels was only detected in the intestine of animals treated with HT + SEV ( 〈 0.05). A statistically significant increase of intestinal MPO activity was found in the HT + SEV group ( 〈 0.01). Activities of caspase-3 and 7 or matrixmetalloproteinase-2 were not changed in any of the groups investigated, the activity of matrixmetalloproteinase-9 was, however, significantly increased in the HT + SEV group ( 〈 0.05). HT and postconditioning with SEV influence the expression and activity of several small intestinal proteins that are possibly involved in intestinal I/R-mediated events following successful cardiopulmonary resuscitation.
    Keywords: Therapeutic Hypothermia ; Anesthetic Postconditioning ; Intestine ; Ischemia/Reperfusion ; Medicine
    ISSN: 0300-9572
    E-ISSN: 1873-1570
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  • 2
    Language: English
    In: Resuscitation, 2008, Vol.76(3), pp.449-456
    Description: The present study was designed to evaluate the effect of conventional fluid resuscitation and small volume resuscitation alone and combined with arginine vasopressin (AVP) on cerebral perfusion pressure (CPP) and protein S100B during experimental haemorrhagic shock. Thirty anaesthetised pigs underwent a penetrating liver trauma. Following haemodynamic decompensation, pigs received either (1) a combination of crystalloid (40 mL kg ) and colloid (20 mL kg ) solutions (fluid, = 10), (2) hypertonic-hyperoncotic solution (HHS; 4 mL kg ) combined with normal saline (HHS + NS; = 10) or (3) HHS combined with AVP (0.2 U kg followed by an infusion of 2 U kg h ; HHS + AVP; = 10). Compared to baseline, CPP decreased and S100B levels increased significantly at haemodynamic decompensation (S100B: fluid, 0.52 ± 0.23 μg L vs. 0.85 ± 0.37 μg L , 〈 0.05; HHS + NS, 0.47 ± 0.18 μg L vs. 0.90 ± 0.33 μg L , 〈 0.05; HHS + AVP, 0.53 ± 0.18 μg L vs. 0.90 ± 0.39 μg L , 〈 0.01). During the initial 10 min of therapy, CPP of HHS + NS was significantly higher compared to the fluid group, increased more rapidly in the HHS + AVP group, but was not significantly different thereafter. S100B levels decreased close to baseline values ( 〈 0.001), and did not differ between groups. HHS + AVP resulted in higher CPP compared to fluid and HHS + NS in the initial phase of therapy, but did not differ thereafter. Haemorrhage-induced hypotension yielded increased S100B levels that were comparable in groups throughout the study period.
    Keywords: Cerebral Ischaemia ; S100b ; Haemorrhage ; Shock ; Vasopressin ; Medicine
    ISSN: 0300-9572
    E-ISSN: 1873-1570
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  • 3
    Language: English
    In: Resuscitation, 2009, Vol.80(2), pp.199-203
    Description: Survival rate after out-of-hospital cardiac arrest (OHCA) has not significantly increased over the last decade. However, survival rate has been used as a quality benchmark for many emergency medical services. A uniform resuscitation registry may be advantageous for quality management of cardiopulmonary resuscitation (CPR). This study was conducted to evaluate the establishment of a national CPR registry in Germany. A prospective cohort study was performed that included 469 patients who experienced OHCA requiring CPR in the metropolitan area of Dortmund, Germany. Cardiac arrest was defined as concomitant appearance of unconsciousness, apnoea or gasping and pulselessness. All data were collected via a secure and confidential paper-based method as the data set ‘Preclinical care’. Quality of data was classified as ‘good’ in 33.4%, ‘moderate’ in 48.4%, and ‘bad’ in 18.2% of the patients, respectively. Sixty-two percent had OHCA in private residences, 24% of the patients had a first monitored rhythm of ventricular fibrillation (VF) or ventricular tachycardia (VT), 35.2% had return of spontaneous circulation (ROSC) on scene, and patients presenting VF/VT as the first monitored rhythm had higher ROSC rates (51.3%) compared to patients with asystole (22.6%). The data set ‘Preclinical care’ proved to be congruent with the Utstein style, provided further information for national and international comparisons, and enabled a detailed analysis. Optimisation of data collection and introduction of strict control mechanisms may further improve data quality.
    Keywords: Cardiopulmonary Resuscitation ; Circulation ; Cardiac Arrest ; Emergency Medical Services ; Resuscitation ; Medicine
    ISSN: 0300-9572
    E-ISSN: 1873-1570
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