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Ineichen BV, Furrer E, Grüninger SL, Zürrer WE, Macleod MR. Analysis of animal-to-human translation shows that only 5% of animal-tested therapeutic interventions obtain regulatory approval for human applications. PLoS Biol 2024; 22:e3002667. [PMID: 38870090 PMCID: PMC11175415 DOI: 10.1371/journal.pbio.3002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/07/2024] [Indexed: 06/15/2024] Open
Abstract
There is an ongoing debate about the value of animal experiments to inform medical practice, yet there are limited data on how well therapies developed in animal studies translate to humans. We aimed to assess 2 measures of translation across various biomedical fields: (1) The proportion of therapies which transition from animal studies to human application, including involved timeframes; and (2) the consistency between animal and human study results. Thus, we conducted an umbrella review, including English systematic reviews that evaluated the translation of therapies from animals to humans. Medline, Embase, and Web of Science Core Collection were searched from inception until August 1, 2023. We assessed the proportion of therapeutic interventions advancing to any human study, a randomized controlled trial (RCT), and regulatory approval. We meta-analyzed the concordance between animal and human studies. The risk of bias was probed using a 10-item checklist for systematic reviews. We included 122 articles, describing 54 distinct human diseases and 367 therapeutic interventions. Neurological diseases were the focus of 32% of reviews. The overall proportion of therapies progressing from animal studies was 50% to human studies, 40% to RCTs, and 5% to regulatory approval. Notably, our meta-analysis showed an 86% concordance between positive results in animal and clinical studies. The median transition times from animal studies were 5, 7, and 10 years to reach any human study, an RCT, and regulatory approval, respectively. We conclude that, contrary to widespread assertions, the rate of successful animal-to-human translation may be higher than previously reported. Nonetheless, the low rate of final approval indicates potential deficiencies in the design of both animal studies and early clinical trials. To ameliorate the efficacy of translating therapies from bench to bedside, we advocate for enhanced study design robustness and the reinforcement of generalizability.
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Affiliation(s)
- Benjamin V. Ineichen
- Centre for Reproducible Science, University of Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Eva Furrer
- Centre for Reproducible Science, University of Zurich, Zurich, Switzerland
| | - Servan L. Grüninger
- Centre for Reproducible Science, University of Zurich, Zurich, Switzerland
- Department of Mathematics, University of Zurich, Zurich, Switzerland
| | - Wolfgang E. Zürrer
- Centre for Reproducible Science, University of Zurich, Zurich, Switzerland
| | - Malcolm R. Macleod
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
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2
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Butler D, Reyes DR. Heart-on-a-chip systems: disease modeling and drug screening applications. LAB ON A CHIP 2024; 24:1494-1528. [PMID: 38318723 DOI: 10.1039/d3lc00829k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide, casting a substantial economic footprint and burdening the global healthcare system. Historically, pre-clinical CVD modeling and therapeutic screening have been performed using animal models. Unfortunately, animal models oftentimes fail to adequately mimic human physiology, leading to a poor translation of therapeutics from pre-clinical trials to consumers. Even those that make it to market can be removed due to unforeseen side effects. As such, there exists a clinical, technological, and economical need for systems that faithfully capture human (patho)physiology for modeling CVD, assessing cardiotoxicity, and evaluating drug efficacy. Heart-on-a-chip (HoC) systems are a part of the broader organ-on-a-chip paradigm that leverages microfluidics, tissue engineering, microfabrication, electronics, and gene editing to create human-relevant models for studying disease, drug-induced side effects, and therapeutic efficacy. These compact systems can be capable of real-time measurements and on-demand characterization of tissue behavior and could revolutionize the drug development process. In this review, we highlight the key components that comprise a HoC system followed by a review of contemporary reports of their use in disease modeling, drug toxicity and efficacy assessment, and as part of multi-organ-on-a-chip platforms. We also discuss future perspectives and challenges facing the field, including a discussion on the role that standardization is expected to play in accelerating the widespread adoption of these platforms.
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Affiliation(s)
- Derrick Butler
- Microsystems and Nanotechnology Division, National Institute of Standards and Technology, Gaithersburg, MD 20899, USA.
| | - Darwin R Reyes
- Microsystems and Nanotechnology Division, National Institute of Standards and Technology, Gaithersburg, MD 20899, USA.
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Dou W, Malhi M, Zhao Q, Wang L, Huang Z, Law J, Liu N, Simmons CA, Maynes JT, Sun Y. Microengineered platforms for characterizing the contractile function of in vitro cardiac models. MICROSYSTEMS & NANOENGINEERING 2022; 8:26. [PMID: 35299653 PMCID: PMC8882466 DOI: 10.1038/s41378-021-00344-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/12/2021] [Accepted: 12/03/2021] [Indexed: 05/08/2023]
Abstract
Emerging heart-on-a-chip platforms are promising approaches to establish cardiac cell/tissue models in vitro for research on cardiac physiology, disease modeling and drug cardiotoxicity as well as for therapeutic discovery. Challenges still exist in obtaining the complete capability of in situ sensing to fully evaluate the complex functional properties of cardiac cell/tissue models. Changes to contractile strength (contractility) and beating regularity (rhythm) are particularly important to generate accurate, predictive models. Developing new platforms and technologies to assess the contractile functions of in vitro cardiac models is essential to provide information on cell/tissue physiologies, drug-induced inotropic responses, and the mechanisms of cardiac diseases. In this review, we discuss recent advances in biosensing platforms for the measurement of contractile functions of in vitro cardiac models, including single cardiomyocytes, 2D monolayers of cardiomyocytes, and 3D cardiac tissues. The characteristics and performance of current platforms are reviewed in terms of sensing principles, measured parameters, performance, cell sources, cell/tissue model configurations, advantages, and limitations. In addition, we highlight applications of these platforms and relevant discoveries in fundamental investigations, drug testing, and disease modeling. Furthermore, challenges and future outlooks of heart-on-a-chip platforms for in vitro measurement of cardiac functional properties are discussed.
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Affiliation(s)
- Wenkun Dou
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8 Canada
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8 Canada
| | - Manpreet Malhi
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8 Canada
- Department of Biochemistry, University of Toronto, Toronto, ON M5S 1A8 Canada
| | - Qili Zhao
- Institute of Robotics and Automatic Information System and the Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, 300350 China
| | - Li Wang
- School of Mechanical & Automotive Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan, 250353 China
| | - Zongjie Huang
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8 Canada
| | - Junhui Law
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8 Canada
| | - Na Liu
- School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, 200444 China
| | - Craig A. Simmons
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8 Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9 Canada
- Translational Biology & Engineering Program, Ted Rogers Centre for Heart Research, Toronto, ON M5G 1M1 Canada
| | - Jason T. Maynes
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8 Canada
- Department of Biochemistry, University of Toronto, Toronto, ON M5S 1A8 Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON M5S 1A8 Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8 Canada
| | - Yu Sun
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S 3G8 Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S 3G9 Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON M5S 3G4 Canada
- Department of Computer Science, University of Toronto, Toronto, ON M5T 3A1 Canada
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Márquez-Hernández VV, Gutiérrez-Puertas L, Garrido-Molina JM, García-Viola A, Alcayde-García A, Aguilera-Manrique G. Worldviews on Evidence-Based Cardiopulmonary Resuscitation Using a Novel Method. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189536. [PMID: 34574460 PMCID: PMC8466558 DOI: 10.3390/ijerph18189536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
The evaluation of scientific content by researchers, as well as the knowledge networks and working groups of cardiopulmonary resuscitation, can help to improve and expand new scientific evidence in this field. The aim of this study was to identify the global scientific publications on cardiopulmonary resuscitation research using a novel method. The method used was based on obtaining bibliographic data automatically from scientific publications through the use of the Scopus Database API Interface. A total of 17,917 results were obtained, with a total of 60,226 reports and 53,634 authors. Six categories were detected with 38.56% corresponding to cardiac arrest, 21.8% to cardiopulmonary resuscitation, 17.16% to life-support training and education, 12.45% to ethics and decision-making in cardiac arrest, 4.77% to therapeutic treatment, and 3.72% to life-support techniques. Analyzing and identifying the main scientific contributions to this field of study can make it possible to establish collaboration networks and propose new lines of research, as well as to unify criteria for action. Future research should delve into the analyses of the other elements involved in this area.
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Affiliation(s)
- Verónica V. Márquez-Hernández
- Deparment of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (V.V.M.-H.); (J.M.G.-M.); (A.G.-V.); (G.A.-M.)
- Research Group for Health Sciences CTS-451, Health Research Center, 04120 Almería, Spain
| | - Lorena Gutiérrez-Puertas
- Deparment of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (V.V.M.-H.); (J.M.G.-M.); (A.G.-V.); (G.A.-M.)
- Experimental and Applied Neuropsychology Research Group HUM-061, 04120 Almería, Spain
- Correspondence: ; Tel.: +34-950-21-45-85
| | - José M. Garrido-Molina
- Deparment of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (V.V.M.-H.); (J.M.G.-M.); (A.G.-V.); (G.A.-M.)
| | - Alba García-Viola
- Deparment of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (V.V.M.-H.); (J.M.G.-M.); (A.G.-V.); (G.A.-M.)
| | | | - Gabriel Aguilera-Manrique
- Deparment of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain; (V.V.M.-H.); (J.M.G.-M.); (A.G.-V.); (G.A.-M.)
- Research Group for Health Sciences CTS-451, Health Research Center, 04120 Almería, Spain
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Abstract
Cardiac arrest results from a broad range of etiologies that can be broadly grouped as sudden and asphyxial. Animal studies point to differences in injury pathways invoked in the heart and brain that drive injury and outcome after these different forms of cardiac arrest. Present guidelines largely ignore etiology in their management recommendations. Existing clinical data reveal significant heterogeneity in the utility of presently employed resuscitation and postresuscitation strategies based on etiology. The development of future neuroprotective and cardioprotective therapies should also take etiology into consideration to optimize the chances for successful translation.
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Perkins GD, Ji C, Achana F, Black JJ, Charlton K, Crawford J, de Paeztron A, Deakin C, Docherty M, Finn J, Fothergill RT, Gates S, Gunson I, Han K, Hennings S, Horton J, Khan K, Lamb S, Long J, Miller J, Moore F, Nolan J, O'Shea L, Petrou S, Pocock H, Quinn T, Rees N, Regan S, Rosser A, Scomparin C, Slowther A, Lall R. Adrenaline to improve survival in out-of-hospital cardiac arrest: the PARAMEDIC2 RCT. Health Technol Assess 2021; 25:1-166. [PMID: 33861194 PMCID: PMC8072520 DOI: 10.3310/hta25250] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adrenaline has been used as a treatment for cardiac arrest for many years, despite uncertainty about its effects on long-term outcomes and concerns that it may cause worse neurological outcomes. OBJECTIVES The objectives were to evaluate the effects of adrenaline on survival and neurological outcomes, and to assess the cost-effectiveness of adrenaline use. DESIGN This was a pragmatic, randomised, allocation-concealed, placebo-controlled, parallel-group superiority trial and economic evaluation. Costs are expressed in Great British pounds and reported in 2016/17 prices. SETTING This trial was set in five NHS ambulance services in England and Wales. PARTICIPANTS Adults treated for an out-of-hospital cardiac arrest were included. Patients were ineligible if they were pregnant, if they were aged < 16 years, if the cardiac arrest had been caused by anaphylaxis or life-threatening asthma, or if adrenaline had already been given. INTERVENTIONS Participants were randomised to either adrenaline (1 mg) or placebo in a 1 : 1 allocation ratio by the opening of allocation-concealed treatment packs. MAIN OUTCOME MEASURES The primary outcome was survival to 30 days. The secondary outcomes were survival to hospital admission, survival to hospital discharge, survival at 3, 6 and 12 months, neurological outcomes and health-related quality of life through to 6 months. The economic evaluation assessed the incremental cost per quality-adjusted life-year gained from the perspective of the NHS and Personal Social Services. Participants, clinical teams and those assessing patient outcomes were masked to the treatment allocation. RESULTS From December 2014 to October 2017, 8014 participants were assigned to the adrenaline (n = 4015) or to the placebo (n = 3999) arm. At 30 days, 130 out of 4012 participants (3.2%) in the adrenaline arm and 94 out of 3995 (2.4%) in the placebo arm were alive (adjusted odds ratio for survival 1.47, 95% confidence interval 1.09 to 1.97). For secondary outcomes, survival to hospital admission was higher for those receiving adrenaline than for those receiving placebo (23.6% vs. 8.0%; adjusted odds ratio 3.83, 95% confidence interval 3.30 to 4.43). The rate of favourable neurological outcome at hospital discharge was not significantly different between the arms (2.2% vs. 1.9%; adjusted odds ratio 1.19, 95% confidence interval 0.85 to 1.68). The pattern of improved survival but no significant improvement in neurological outcomes continued through to 6 months. By 12 months, survival in the adrenaline arm was 2.7%, compared with 2.0% in the placebo arm (adjusted odds ratio 1.38, 95% confidence interval 1.00 to 1.92). An adjusted subgroup analysis did not identify significant interactions. The incremental cost-effectiveness ratio for adrenaline was estimated at £1,693,003 per quality-adjusted life-year gained over the first 6 months after the cardiac arrest event and £81,070 per quality-adjusted life-year gained over the lifetime of survivors. Additional economic analyses estimated incremental cost-effectiveness ratios for adrenaline at £982,880 per percentage point increase in overall survival and £377,232 per percentage point increase in neurological outcomes over the first 6 months after the cardiac arrest. LIMITATIONS The estimate for survival with a favourable neurological outcome is imprecise because of the small numbers of patients surviving with a good outcome. CONCLUSIONS Adrenaline improved long-term survival, but there was no evidence that it significantly improved neurological outcomes. The incremental cost-effectiveness ratio per quality-adjusted life-year exceeds the threshold of £20,000-30,000 per quality-adjusted life-year usually supported by the NHS. FUTURE WORK Further research is required to better understand patients' preferences in relation to survival and neurological outcomes after out-of-hospital cardiac arrest and to aid interpretation of the trial findings from a patient and public perspective. TRIAL REGISTRATION Current Controlled Trials ISRCTN73485024 and EudraCT 2014-000792-11. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Felix Achana
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - John Jm Black
- South Central Ambulance Service NHS Foundation Trust, Bicester, UK
| | - Karl Charlton
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James Crawford
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Adam de Paeztron
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Mark Docherty
- West Midlands Ambulance Service University NHS Foundation Trust, Brierley Hill, UK
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin University, Perth, WA, Australia
| | | | - Simon Gates
- Cancer Research Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, UK
| | - Imogen Gunson
- West Midlands Ambulance Service University NHS Foundation Trust, Brierley Hill, UK
| | - Kyee Han
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Susie Hennings
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jessica Horton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kamran Khan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Lamb
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - John Long
- Patient and Public Involvement Representative, Warwick, UK
| | - Joshua Miller
- West Midlands Ambulance Service University NHS Foundation Trust, Brierley Hill, UK
| | - Fionna Moore
- South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK
| | - Jerry Nolan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - Stavros Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Pocock
- South Central Ambulance Service NHS Foundation Trust, Bicester, UK
| | - Tom Quinn
- Emergency, Cardiovascular and Critical Care Research Group, Faculty of Health, Social Care and Education, Kingston University London and St George's, University of London, London, UK
| | - Nigel Rees
- Welsh Ambulance Service NHS Trust, St Asaph, UK
| | - Scott Regan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andy Rosser
- West Midlands Ambulance Service University NHS Foundation Trust, Brierley Hill, UK
| | - Charlotte Scomparin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anne Slowther
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Lim D, Lee SH, Kim DH, Kang C, Jeong JH, Lee SB. The effect of high-dose intramuscular epinephrine on the recovery of spontaneous circulation in an asphyxia-induced cardiac arrest rat model. BMC Cardiovasc Disord 2021; 21:113. [PMID: 33632131 PMCID: PMC7908791 DOI: 10.1186/s12872-021-01917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obtaining vascular access can be challenging during resuscitation following cardiac arrest, and it is particularly difficult and time-consuming in paediatric patients. We aimed to compare the efficacy of high-dose intramuscular (IM) versus intravascular (IV) epinephrine administration with regard to the return of spontaneous circulation (ROSC) in an asphyxia-induced cardiac arrest rat model. METHODS Forty-five male Sprague-Dawley rats were used for these experiments. Cardiac arrest was induced by asphyxia, and defined as a decline in mean arterial pressure (MAP) to 20 mmHg. After asphyxia-induced cardiac arrest, the rats were randomly allocated into one of 3 groups (control saline group, IV epinephrine group, and IM epinephrine group). After 540 s of cardiac arrest, cardiopulmonary resuscitation was performed, and IV saline (0.01 cc/kg), IV (0.01 mg/kg, 1:100,000) epinephrine or IM (0.05 mg/kg, 1:100,000) epinephrine was administered. ROSC was defined as the achievement of an MAP above 40 mmHg for more than 1 minute. Rates of ROSC, haemodynamics, and arterial blood gas analysis were serially observed. RESULTS The ROSC rate (61.5%) of the IM epinephrine group was less than that in the IV epinephrine group (100%) but was higher than that of the control saline group (15.4%) (log-rank test). There were no differences in MAP between the two groups, but HR in the IM epinephrine group (beta coefficient = 1.02) decreased to a lesser extent than that in the IV epinephrine group with time. CONCLUSIONS IM epinephrine induced better ROSC rates compared to the control saline group in asphyxia-induced cardiac arrest, but not compared to IV epinephrine. The IM route of epinephrine administration may be a promising option in an asphyxia-induced cardiac arrest.
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Affiliation(s)
- Daesung Lim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Samjeongja-ro 11, Seongsan-gu, Changwon, Gyeongsangnam-Do, 51472, Republic of Korea
| | - Soo Hoon Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Gangnam-ro 79, Jinju, Gyeongsangnam-Do, 52727, Republic of Korea.
| | - Dong Hoon Kim
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Gangnam-ro 79, Jinju, Gyeongsangnam-Do, 52727, Republic of Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Gangnam-ro 79, Jinju, Gyeongsangnam-Do, 52727, Republic of Korea
| | - Jin Hee Jeong
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Gangnam-ro 79, Jinju, Gyeongsangnam-Do, 52727, Republic of Korea
| | - Sang Bong Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Gangnam-ro 79, Jinju, Gyeongsangnam-Do, 52727, Republic of Korea
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Lalu MM, Montroy J, Begley CG, Bubela T, Hunniford V, Ripsman D, Wesch N, Kimmelman J, Macleod M, Moher D, Tieu A, Sikora L, Fergusson DA. Identifying and understanding factors that affect the translation of therapies from the laboratory to patients: a study protocol. F1000Res 2020; 9:485. [PMID: 33123348 PMCID: PMC7570319 DOI: 10.12688/f1000research.23663.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The process of translating preclinical findings into a clinical setting takes decades. Previous studies have suggested that only 5-10% of the most promising preclinical studies are successfully translated into viable clinical applications. The underlying determinants of this low success rate (e.g. poor experimental design, suboptimal animal models, poor reporting) have not been examined in an empirical manner. Our study aims to determine the contemporary success rate of preclinical-to-clinical translation, and subsequently determine if an association between preclinical study design and translational success/failure exists. Methods: Established systematic review methodology will be used with regards to the literature search, article screening and study selection process. Preclinical, basic science studies published in high impact basic science journals between 1995 and 2015 will be included. Included studies will focus on publicly available interventions with potential clinical promise. The primary outcome will be successful clinical translation of promising therapies - defined as the conduct of at least one Phase II trial (or greater) with a positive finding. A case-control study will then be performed to evaluate the association between elements of preclinical study design and reporting and the likelihood of successful translation. Discussion: This study will provide a comprehensive analysis of the therapeutic translation from the laboratory bench to the bedside. Importantly, any association between factors of study design and the success of translation will be identified. These findings may inform future research teams attempting preclinical-to-clinical translation. Results will be disseminated to identified knowledge users that fund/support preclinical research.
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Affiliation(s)
- Manoj M. Lalu
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Montroy
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Tania Bubela
- Faculty of Health Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Victoria Hunniford
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Ripsman
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Neil Wesch
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Malcolm Macleod
- Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Moher
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alvin Tieu
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A. Fergusson
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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9
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Lalu MM, Montroy J, Begley CG, Bubela T, Hunniford V, Ripsman D, Wesch N, Kimmelman J, Macleod M, Moher D, Tieu A, Sikora L, Fergusson DA. Identifying and understanding factors that affect the translation of therapies from the laboratory to patients: a study protocol. F1000Res 2020; 9:485. [PMID: 33123348 PMCID: PMC7570319 DOI: 10.12688/f1000research.23663.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 03/31/2024] Open
Abstract
Background: The process of translating preclinical findings into a clinical setting takes decades. Previous studies have suggested that only 5-10% of the most promising preclinical studies are successfully translated into viable clinical applications. The underlying determinants of this low success rate (e.g. poor experimental design, suboptimal animal models, poor reporting) have not been examined in an empirical manner. Our study aims to determine the contemporary success rate of preclinical-to-clinical translation, and subsequently determine if an association between preclinical study design and translational success/failure exists. Methods: Established systematic review methodology will be used with regards to the literature search, article screening and study selection process. Preclinical, basic science studies published in high impact basic science journals between 1995 and 2015 will be included. Included studies will focus on publicly available interventions with potential clinical promise. The primary outcome will be successful clinical translation of promising therapies - defined as the conduct of at least one Phase II trial (or greater) with a positive finding. A case-control study will then be performed to evaluate the association between elements of preclinical study design and reporting and the likelihood of successful translation. Discussion: This study will provide a comprehensive analysis of the therapeutic translation from the laboratory bench to the bedside. Importantly, any association between factors of study design and the success of translation will be identified. These findings may inform future research teams attempting preclinical-to-clinical translation. Results will be disseminated to identified knowledge users that fund/support preclinical research.
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Affiliation(s)
- Manoj M. Lalu
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Montroy
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Tania Bubela
- Faculty of Health Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Victoria Hunniford
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Ripsman
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Neil Wesch
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Malcolm Macleod
- Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Moher
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alvin Tieu
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A. Fergusson
- Clinical Epidemiology Program, Ottawa General Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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10
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Perkins GD, Kenna C, Ji C, Deakin CD, Nolan JP, Quinn T, Scomparin C, Fothergill R, Gunson I, Pocock H, Rees N, O'Shea L, Finn J, Gates S, Lall R. The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial. Intensive Care Med 2020; 46:426-436. [PMID: 31912202 PMCID: PMC7067734 DOI: 10.1007/s00134-019-05836-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/18/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the time to drug administration in patients with a witnessed cardiac arrest enrolled in the Pre-Hospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest (PARAMEDIC2) randomised controlled trial. METHODS The PARAMEDIC2 trial was undertaken across 5 NHS ambulance services in England and Wales with randomisation between December 2014 and October 2017. Patients with an out-of-hospital cardiac arrest who were unresponsive to initial resuscitation attempts were randomly assigned to 1 mg intravenous adrenaline or matching placebo according to treatment packs that were identical apart from treatment number. Participants and study staff were masked to treatment allocation. RESULTS 8016 patients were enrolled, 4902 sustained a witnessed cardiac arrest of whom 2437 received placebo and 2465 received adrenaline. The odds of return of spontaneous circulation decreased in both groups over time but at a greater rate in the placebo arm odds ratio (OR) 0.93 (95% CI 0.92-0.95) compared with the adrenaline arm OR 0.96 (95% CI 0.95-0.97); interaction OR: 1.03, 95% CI 1.01-1.05, p = 0.005. By contrast, although the rate of survival and favourable neurological outcome decreased as time to treatment increased, the rates did not differ between the adrenaline and placebo groups. CONCLUSION The rate of return of spontaneous circulation, survival and favourable neurological outcomes decrease over time. As time to drug treatment increases, adrenaline increases the chances of return of spontaneous circulation. Longer term outcomes were not affected by the time to adrenaline administration. (ISRCTN73485024).
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Affiliation(s)
- Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK.
- Heartlands Hospital, University Hospitals Birmingham, Birmingham, B9 5SS, UK.
| | - Claire Kenna
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
| | - Chen Ji
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
| | - Charles D Deakin
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, SO21 2RU, UK
- NIHR Southampton Respiratory Biomedical Research Unit, Southampton, SO16 6YD, UK
| | - Jerry P Nolan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
- Royal United Hospital, Bath, BA1 3NG, UK
| | - Tom Quinn
- Kingston University and St George's, University of London, 6th Floor, Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK
| | | | - Rachael Fothergill
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
- London Ambulance Service NHS Trust, 8-20 Pocock Street, London, SE1 0BW, UK
| | - Imogen Gunson
- West Midlands Ambulance Service University NHS Foundation Trust, Brierley Hill, West Midlands, DY5 1LX, UK
| | - Helen Pocock
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, SO21 2RU, UK
| | - Nigel Rees
- Welsh Ambulance Services NHS Trust, Swansea, Wales, SA2 8PP, UK
| | - Lyndsey O'Shea
- Welsh Ambulance Services NHS Trust, Swansea, Wales, SA2 8PP, UK
| | | | - Simon Gates
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK
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11
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Lalu MM, Montroy J, Dowlatshahi D, Hutton B, Juneau P, Wesch N, Y Zhang S, McGinn R, Corbett D, Stewart DJ, A Fergusson D. From the Lab to Patients: a Systematic Review and Meta-Analysis of Mesenchymal Stem Cell Therapy for Stroke. Transl Stroke Res 2019; 11:345-364. [PMID: 31654281 DOI: 10.1007/s12975-019-00736-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 01/01/2023]
Abstract
There may be the potential to improve stroke recovery with mesenchymal stem cells (MSCs); however, questions about the efficacy and safety of this treatment remain. To address these issues and inform future studies, we performed a preclinical and clinical systematic review of MSC therapy for subacute and chronic ischemic stroke. MEDLINE, Embase, the Cochrane Register of Controlled Trials, and PubMed were searched. For the clinical review, interventional and observational studies of MSC therapy in ischemic stroke patients were included. For the preclinical review, interventional studies of MSC therapy using in vivo animal models of subacute or chronic stroke were included. Measures of safety and efficacy were assessed. Eleven clinical and 76 preclinical studies were included. Preclinically, MSC therapy was associated with significant benefits for multiple measures of motor and neurological function. Clinically, MSC therapy appeared to be safe, with no increase in adverse events reported (with the exception of self-limited fever immediately following injection). However, the efficacy of treatment was less apparent, with significant heterogeneity in both study design and effect size being observed. Additionally, in the only randomized phase II study to date, efficacy of MSC therapy was not observed. Preclinically, MSC therapy demonstrated considerable efficacy. Although MSC therapy demonstrated safety in the clinical setting, efficacy has yet to be determined. Future studies will need to address the discordance in the continuity of evidence as MSC therapy has been translated from "bench-to-bedside".
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Affiliation(s)
- Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada.
- Clinical Epidemiology Program, Blueprint Translational Group, The Ottawa Hospital Research Institute, Ottawa, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada.
| | - Joshua Montroy
- Clinical Epidemiology Program, Blueprint Translational Group, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dar Dowlatshahi
- Clinical Epidemiology Program, Blueprint Translational Group, The Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, Neurology, The Ottawa Hospital, Ottawa, Canada
| | - Brian Hutton
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Pascale Juneau
- Clinical Epidemiology Program, Blueprint Translational Group, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Neil Wesch
- Clinical Epidemiology Program, Blueprint Translational Group, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sarah Y Zhang
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Ryan McGinn
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
- Canadian Partnership for Stroke Recovery, Ottawa, Canada
| | - Duncan J Stewart
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Blueprint Translational Group, The Ottawa Hospital Research Institute, Ottawa, Canada
- Knowledge Synthesis Group, Ottawa Hospital Research Institute, Ottawa, Canada
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12
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Piktel JS, Wilson LD. Translational Models of Arrhythmia Mechanisms and Susceptibility: Success and Challenges of Modeling Human Disease. Front Cardiovasc Med 2019; 6:135. [PMID: 31552276 PMCID: PMC6748164 DOI: 10.3389/fcvm.2019.00135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/27/2019] [Indexed: 01/10/2023] Open
Abstract
We discuss large animal translational models of arrhythmia susceptibility and sudden cardiac death, focusing on important considerations when interpreting the data derived before applying them to human trials. The utility of large animal models of arrhythmia and the pros and cons of specific translational large animals used will be discussed, including the necessary tradeoffs between models designed to derive mechanisms vs. those to test therapies. Recent technical advancements which can be applied to large animal models of arrhythmias to better elucidate mechanistic insights will be introduced. Finally, some specific examples of past successes and challenges in translating the results of large animal models of arrhythmias to clinical trials and practice will be examined, and common themes regarding the success and failure of translating studies to therapy in man will be discussed.
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Affiliation(s)
| | - Lance D. Wilson
- Department of Emergency Medicine, Emergency Care Research Institute and Heart and Vascular Research Center, MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United States
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13
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Al-Mulhim MA, Alshahrani MS, Asonto LP, Abdulhady A, Almutairi TM, Hajji M, Alrubaish MA, Almulhim KN, Al-Sulaiman MH, Al-Qahtani LB. Impact of epinephrine administration frequency in out-of-hospital cardiac arrest patients: a retrospective analysis in a tertiary hospital setting. J Int Med Res 2019; 47:4272-4283. [PMID: 31311363 PMCID: PMC6753528 DOI: 10.1177/0300060519860952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction Epinephrine is recommended for patients with out-of-hospital cardiac arrest
(OHCA). However, whether epinephrine improves or adversely affects OHCA
outcomes is controversial. Objectives This study aims to determine whether the frequency of epinephrine
administration impacts OHCA patient survival. Methods We conducted a retrospective analysis of OHCA cases registered in the
Emergency Department at King Fahd University Hospital, Saudi Arabia between
2005 and 2015. The primary outcomes were mortality and survival rates until
discharge. The impact of epinephrine administration timing and frequency on
patient survival was analyzed. Results Data from 300 OHCA cases were analyzed. Among them, 66.3% were men, and the
overall mean age of 50.4 ± 20.6 years. The overall survival rate until
hospital discharge was 12%. There was no statistically significant
difference between in gender, age, or time interval to the first epinephrine
dose in the survival and non-survival groups. Only the number of epinephrine
doses was related to the survival outcome. Conclusion Non-survivors received significantly more epinephrine doses compared with
survivors. However, a causal relationship between OHCA patient survival and
epinephrine dose and time cannot be confirmed. Further studies are needed to
investigate whether the long-term outcomes in OHCA patients are influenced
by the timing and frequency of epinephrine administration.
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Affiliation(s)
- Mohammed A Al-Mulhim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Mohammed S Alshahrani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Laila Perlas Asonto
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Ahmad Abdulhady
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Talal M Almutairi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | | | - Mohammed A Alrubaish
- College of Medicine, Imam Abdulrahman Bin Faisal University, Kingdom of Saudi Arabia
| | - Khalid N Almulhim
- College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
| | | | - Layla B Al-Qahtani
- Children's Specialist Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Elmer J, Flickinger KL, Anderson MW, Koller AC, Sundermann ML, Dezfulian C, Okonkwo DO, Shutter LA, Salcido DD, Callaway CW, Menegazzi JJ. Effect of neuromonitor-guided titrated care on brain tissue hypoxia after opioid overdose cardiac arrest. Resuscitation 2018; 129:121-126. [PMID: 29679696 PMCID: PMC6054552 DOI: 10.1016/j.resuscitation.2018.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/23/2018] [Accepted: 04/13/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Brain tissue hypoxia may contribute to preventable secondary brain injury after cardiac arrest. We developed a porcine model of opioid overdose cardiac arrest and post-arrest care including invasive, multimodal neurological monitoring of regional brain physiology. We hypothesized brain tissue hypoxia is common with usual post-arrest care and can be prevented by modifying mean arterial pressure (MAP) and arterial oxygen concentration (PaO2). METHODS We induced opioid overdose and cardiac arrest in sixteen swine, attempted resuscitation after 9 min of apnea, and randomized resuscitated animals to three alternating 6-h blocks of standard or titrated care. We invasively monitored physiological parameters including brain tissue oxygen (PbtO2). During standard care blocks, we maintained MAP > 65 mmHg and oxygen saturation 94-98%. During titrated care, we targeted PbtO2 > 20 mmHg. RESULTS Overall, 10 animals (63%) achieved ROSC after a median of 12.4 min (range 10.8-21.5 min). PbtO2 was higher during titrated care than standard care blocks (unadjusted β = 0.60, 95% confidence interval (CI) 0.42-0.78, P < 0.001). In an adjusted model controlling for MAP, vasopressors, sedation, and block sequence, PbtO2 remained higher during titrated care (adjusted β = 0.75, 95%CI 0.43-1.06, P < 0.001). At three predetermined thresholds, brain tissue hypoxia was significantly less common during titrated care blocks (44 vs 2% of the block duration spent below 20 mmHg, P < 0.001; 21 vs 0% below 15 mmHg, P < 0.001; and, 7 vs 0% below 10 mmHg, P = .01). CONCLUSIONS In this model of opioid overdose cardiac arrest, brain tissue hypoxia is common and treatable. Further work will elucidate best strategies and impact of titrated care on functional outcomes.
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Affiliation(s)
- Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.
| | - Katharyn L Flickinger
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Maighdlin W Anderson
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Allison C Koller
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Matthew L Sundermann
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Cameron Dezfulian
- Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Lori A Shutter
- Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - David D Salcido
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - James J Menegazzi
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
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15
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Impact of Early Vasopressor Administration on Neurological Outcomes after Prolonged Out-of-Hospital Cardiac Arrest. Prehosp Disaster Med 2017; 32:297-304. [PMID: 28222830 DOI: 10.1017/s1049023x17000115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Vasopressors are associated with return of spontaneous circulation (ROSC), but no long-term benefit has been demonstrated in randomized trials. However, these trials did not control for the timing of vasopressor administration which may influence outcomes. Consequently, the objective of this study was to develop a model describing the likelihood of favorable neurological outcome (cerebral performance category [CPC] 1 or 2) as a function of the public safety answering point call receipt (PSAP)-to-pressor-interval (PPI) in prolonged out-of-hospital cardiac arrest. Hypothesis The likelihood of favorable neurological outcome declines with increasing PPI. METHODS This investigation was a retrospective study of cardiac arrest using linked data from the Cardiac Arrest Registry to Enhance Survival (CARES) database (Centers for Disease Control and Prevention [Atlanta, Georgia USA]; American Heart Association [Dallas, Texas USA]; and Emory University Department of Emergency Medicine [Atlanta, Georgia USA]) and the North Carolina (USA) Prehospital Medical Information System. Adult patients suffering a bystander-witnessed, non-traumatic cardiac arrest between January 2012 and June 2014 were included. Logistic regression was used to calculate the adjusted odds ratio (OR) of neurological outcome as a function of PPI, while controlling for patient age, gender, and race; endotracheal intubation (ETI); shockable rhythm; layperson cardiopulmonary resuscitation (CPR); and field hypothermia. RESULTS Of the 2,100 patients meeting inclusion criteria, 913 (43.5%) experienced ROSC, 618 (29.4%) survived to hospital admission, 187 (8.9%) survived to hospital discharge, and 155 (7.4%) were discharged with favorable neurological outcomes (CPC 1 or 2). Favorable neurological outcome was less likely with increasing PPI (OR=0.90; P<.01) and increasing age (OR=0.97; P<.01). Compared to patients with non-shockable rhythms, patients with shockable rhythms were more likely to have favorable neurological outcomes (OR=7.61; P<.01) as were patients receiving field hypothermia (OR=2.13; P<.01). Patient gender, non-Caucasian race, layperson CPR, and ETI were not independent predictors of favorable neurological outcome. CONCLUSION In this evaluation, time to vasopressor administration was significantly associated with favorable neurological outcome. Among adult, witnessed, non-traumatic arrests, the odds of hospital discharge with CPC 1 or 2 declined by 10% for every one-minute delay between PSAP call-receipt and vasopressor administration. These retrospective observations support the notion of a time-dependent function of vasopressor effectiveness on favorable neurological outcome. Large, prospective studies are needed to verify this relationship. Hubble MW , Tyson C . Impact of early vasopressor administration on neurological outcomes after prolonged out-of-hospital cardiac arrest. Prehosp Disaster Med. 2017; 32(3):297-304.
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16
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Jentzer JC, Clements CM, Wright RS, White RD, Jaffe AS. Improving Survival From Cardiac Arrest: A Review of Contemporary Practice and Challenges. Ann Emerg Med 2016; 68:678-689. [PMID: 27318408 DOI: 10.1016/j.annemergmed.2016.05.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/10/2016] [Accepted: 05/16/2016] [Indexed: 12/13/2022]
Abstract
Cardiac arrest is a common and lethal condition frequently encountered by emergency medicine providers. Resuscitation of persons after cardiac arrest remains challenging, and outcomes remain poor overall. Successful resuscitation hinges on timely, high-quality cardiopulmonary resuscitation. The optimal method of providing chest compressions and ventilator support during cardiac arrest remains uncertain. Prompt and effective defibrillation of ventricular arrhythmias is one of the few effective therapies available for treatment of cardiac arrest. Despite numerous studies during several decades, no specific drug delivered during cardiac arrest has been shown to improve neurologically intact survival after cardiac arrest. Extracorporeal circulation can rescue a minority of highly selected patients with refractory cardiac arrest. Current management of pulseless electrical activity is associated with poor outcomes, but it is hoped that a more targeted diagnostic approach based on electrocardiography and bedside cardiac ultrasonography may improve survival. The evolution of postresuscitation care appears to have improved cardiac arrest outcomes in patients who are successfully resuscitated. The initial approach to early stabilization includes standard measures, such as support of pulmonary function, hemodynamic stabilization, and rapid diagnostic assessment. Coronary angiography is often indicated because of the high frequency of unstable coronary artery disease in comatose survivors of cardiac arrest and should be performed early after resuscitation. Optimizing and standardizing our current approach to cardiac arrest resuscitation and postresuscitation care will be essential for developing strategies for improving survival after cardiac arrest.
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Affiliation(s)
- Jacob C Jentzer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| | | | - R Scott Wright
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Roger D White
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Division of Cardiovascular and Thoracic Anesthesia, Mayo Clinic, Rochester, MN
| | - Allan S Jaffe
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Division of Clinical Core Laboratory Services, Mayo Clinic, Rochester, MN
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Lundin A, Djärv T, Engdahl J, Hollenberg J, Nordberg P, Ravn-Fischer A, Ringh M, Rysz S, Svensson L, Herlitz J, Lundgren P. Drug therapy in cardiac arrest: a review of the literature. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 2:54-75. [DOI: 10.1093/ehjcvp/pvv047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/28/2015] [Indexed: 01/01/2023]
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Mader TJ, Coute RA, Kellogg AR, Nathanson BH. Blinded Evaluation of Combination Drug Therapy for Prolonged Ventricular Fibrillation Using a Swine Model of Sudden Cardiac Arrest. PREHOSP EMERG CARE 2015; 20:390-8. [PMID: 26529432 DOI: 10.3109/10903127.2015.1086848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Despite experimental evidence supporting the use of resuscitation drugs in the treatment of sudden cardiac arrest (CA), there are no good human clinical data to support the decades-old practice of giving these medications during out-of-hospital CA resuscitation. We hypothesized that the lack of efficacy in clinical practice in ventricular fibrillation (VF) is the failure-based manner in which resuscitation drugs have historically been administered (one at a time interspersed with chest compressions and a defibrillation attempt, giving the next only if the previous one was ineffective). The aim of this study was to determine if giving and circulating a combination of commonly available, historically used resuscitation drugs together, prior to the first defibrillation attempt after prolonged VF, might improve short-term outcomes compared with the failure-based serial drug approach used in the past. We used a well-established swine model of sudden prolonged untreated VF. Animals were randomized to receive epinephrine (0.01 mg/kg), vasopressin (0.5 U/kg), amiodarone (4 mg/kg), and sodium bicarbonate (1.0 mEq/kg) in series (SERIES group [n = 53]) or a combination of epinephrine (0.01 mg/kg), vasopressin (0.5 U/kg), amiodarone (4 mg/kg), sodium bicarbonate (1.0 mEq/kg), and metoprolol (0.2 mg/kg) (COCKTAIL group) delivered in rapid succession at the beginning of the attempted resuscitation (n = 27). Data were analyzed descriptively. Baseline characteristics and chemistries between the two groups were the same. Termination of VF was statistically similar in the two groups: 88.7% (47/53) versus 85.2% (23/27) p = 0.66, with an adjusted relative risk ratio (RRR) of 0.94 (0.37, 1.15). However, ROSC was higher in the SERIES group (56.6% [30/53] versus 22.2% [6/27], adjusted RRR = 2.83; [1.16, 3.84] p = 0.029) as was 20-minute survival (52.8% [28/53] versus 18.5% [5/27], adjusted RRR = 3.15 [1.14, 4.54] p = 0.032). The combination of drugs studied, at these dosages, inexplicably worsened short-term outcomes after prolonged untreated VF.
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Andersen LW, Berg KM, Saindon BZ, Massaro JM, Raymond TT, Berg RA, Nadkarni VM, Donnino MW. Time to Epinephrine and Survival After Pediatric In-Hospital Cardiac Arrest. JAMA 2015; 314:802-10. [PMID: 26305650 PMCID: PMC6191294 DOI: 10.1001/jama.2015.9678] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Delay in administration of the first epinephrine dose is associated with decreased survival among adults after in-hospital, nonshockable cardiac arrest. Whether this association is true in the pediatric in-hospital cardiac arrest population remains unknown. OBJECTIVE To determine whether time to first epinephrine dose is associated with outcomes in pediatric in-hospital cardiac arrest. DESIGN, SETTING AND PARTICIPANTS We performed an analysis of data from the Get With the Guidelines-Resuscitation registry. We included US pediatric patients (age <18 years) with an in-hospital cardiac arrest and an initial nonshockable rhythm who received at least 1 dose of epinephrine. A total of 1558 patients (median age, 9 months [interquartile range [IQR], 13 days-5 years]) were included in the final cohort. EXPOSURE Time to epinephrine, defined as time in minutes from recognition of loss of pulse to the first dose of epinephrine. MAIN OUTCOMES AND MEASURES The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC), survival at 24 hours, and neurological outcome. A favorable neurological outcome was defined as a score of 1 to 2 on the Pediatric Cerebral Performance Category scale. RESULTS Among the 1558 patients, 487 (31.3%) survived to hospital discharge. The median time to first epinephrine dose was 1 minute (IQR, 0-4; range, 0-20; mean [SD], 2.6 [3.4] minutes). Longer time to epinephrine administration was associated with lower risk of survival to discharge in multivariable analysis (multivariable-adjusted risk ratio [RR] per minute delay, 0.95 [95% CI, 0.93-0.98]). Longer time to epinephrine administration was also associated with decreased risk of ROSC (multivariable-adjusted RR per minute delay, 0.97 [95% CI, 0.96-0.99]), decreased risk of survival at 24 hours (multivariable-adjusted RR per minute delay, 0.97 [95% CI, 0.95-0.99]), and decreased risk of survival with favorable neurological outcome (multivariable-adjusted RR per minute delay, 0.95 [95% CI, 0.91-0.99]). Patients with time to epinephrine administration of longer than 5 minutes (233/1558) compared with those with time to epinephrine of 5 minutes or less (1325/1558) had lower risk of in-hospital survival to discharge (21.0% [49/233] vs 33.1% [438/1325]; multivariable-adjusted RR, 0.75 [95% CI, 0.60-0.93]; P = .01). CONCLUSIONS AND RELEVANCE Among children with in-hospital cardiac arrest with an initial nonshockable rhythm who received epinephrine, delay in administration of epinephrine was associated with decreased chance of survival to hospital discharge, ROSC, 24-hour survival, and survival to hospital discharge with a favorable neurological outcome.
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Affiliation(s)
- Lars W Andersen
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts2Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Katherine M Berg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brian Z Saindon
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Joseph M Massaro
- Harvard Clinical Research Institute, Boston, Massachusetts5Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Tia T Raymond
- Division of Cardiac Critical Care, Department of Pediatrics, Medical City Children's Hospital, Dallas, Texas
| | - Robert A Berg
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Vinay M Nadkarni
- Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Ewy GA, Bobrow BJ, Chikani V, Sanders AB, Otto CW, Spaite DW, Kern KB. The time dependent association of adrenaline administration and survival from out-of-hospital cardiac arrest. Resuscitation 2015; 96:180-5. [PMID: 26307453 DOI: 10.1016/j.resuscitation.2015.08.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/13/2015] [Accepted: 08/17/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recommended for decades, the therapeutic value of adrenaline (epinephrine) in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) is controversial. PURPOSE To investigate the possible time-dependent outcomes associated with adrenaline administration by Emergency Medical Services personnel (EMS). METHODS A retrospective analysis of prospectively collected data from a near statewide cardiac resuscitation database between 1 January 2005 and 30 November 2013. Multivariable logistic regression was used to analyze the effect of the time interval between EMS dispatch and the initial dose of adrenaline on survival. The primary endpoints were survival to hospital discharge and favourable neurologic outcome. RESULTS Data from 3469 patients with witnessed OHCA were analyzed. Their mean age was 66.3 years and 69% were male. An initially shockable rhythm was present in 41.8% of patients. Based on a multivariable logistic regression model with initial adrenaline administration time interval (AATI) from EMS dispatch as the covariate, survival was greatest when adrenaline was administered very early but decreased rapidly with increasing (AATI); odds ratio 0.94 (95% Confidence Interval (CI) 0.92-0.97). The AATI had no significant effect on good neurological outcome (OR=0.96, 95% CI=0.90-1.02). CONCLUSIONS In patients with OHCA, survival to hospital discharge was greater in those treated early with adrenaline by EMS especially in the subset of patients with a shockable rhythm. However survival rapidly decreased with increasing adrenaline administration time intervals (AATI).
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Affiliation(s)
- Gordon A Ewy
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, United States; Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States.
| | - Bentley J Bobrow
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, United States; Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States; Bureau of EMS and Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States
| | - Vatsal Chikani
- Bureau of EMS and Trauma System, Arizona Department of Health Services, Phoenix, AZ, United States
| | - Arthur B Sanders
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, United States; Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Charles W Otto
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, United States; Department of Anesthesiology, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Anesthesiology, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Daniel W Spaite
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Karl B Kern
- Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, United States; Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States; Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States
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Abstract
Cardiac arrest is a dynamic disease that tests the multitasking and leadership abilities of emergency physicians. Providers must simultaneously manage the logistics of resuscitation while searching for the cause of cardiac arrest. The astute clinician will also realize that he or she is orchestrating only one portion of a larger series of events, each of which directly affects patient outcomes. Resuscitation science is rapidly evolving, and emergency providers must be familiar with the latest evidence and controversies surrounding resuscitative techniques. This article reviews evidence, discusses controversies, and offers strategies to provide quality cardiac arrest resuscitation.
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Affiliation(s)
- Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh, Suite 10028, Forbes Tower, Pittsburgh, PA 15260, USA
| | - Joshua C Reynolds
- Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan Street Northeast, Suite 420, Grand Rapids, MI 49503, USA.
| | - Adam Frisch
- Department of Emergency Medicine, Albany Medical Center, 47 New Scotland Avenue, MC 139, Albany, NY 12208, USA
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Hubble MW, Johnson C, Blackwelder J, Collopy K, Houston S, Martin M, Wilkes D, Wiser J. Probability of Return of Spontaneous Circulation as a Function of Timing of Vasopressor Administration in Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2015; 19:457-63. [DOI: 10.3109/10903127.2015.1005262] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Girisgin AS, Kalkan E, Ergin M, Keskin F, Dundar ZD, Kebapcioglu S, Kocak S, Cander B. An experimental study: does the neuroprotective effect increase when hypothermia deepens after traumatic brain injury? IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e21233. [PMID: 26023335 PMCID: PMC4443303 DOI: 10.5812/ircmj.17(4)2015.21233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/16/2014] [Accepted: 11/09/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Experimental approaches have been promising with the use of therapeutic hypothermia after Traumatic Brain Injury (TBI) whereas clinical data have not supported its efficacy. OBJECTIVES This study aimed to investigate whether using selective deeper brain cooling correlates with a more neuroprotective effect on Intracranial Pressure (ICP) increments following TBI in rats. MATERIALS AND METHODS Adult male Sprague-Dawley rats (mean weight = 300 g; n = 25) were subjected to brain injury using a modified Marmarou method. Immediately after the onset of TBI, rats were randomized into three groups. Selective brain cooling was applied around the head using ice packages. Intracranial Temperature (ICT) and ICP were continuously measured at 0, 30, 60, 120, and 180 minutes and recorded for all groups. Group 1 (n = 5) was normothermia and was assigned as the control group. Group 2 (n = 10) received moderate hypothermia with a target ICT of between 32°C - 33°C and Group 3 (n = 10) was given a deeper hypothermia with a target ICT of below 32°C. RESULTS All subjects reached the target ICT by the 30th minute of hypothermia induction. The ICT was significantly different in Group 2 compared to Group 1 only at the 120th minute (P = 0.017), while ICP was significantly lower starting from the 30th minute (P = 0.015). The ICT was significantly lower in Group 3 compared to Groups 1 and 2 starting from the 30th minute (P = 0.001 and P = 0.003, respectively). The ICP was significantly lower in Group 3 compared to Group 1 starting from 30th minute (P = 0.001); however, a significant difference in ICP between Group 3 and Group 2 was observed only at the 180th minute (P = 0.047). CONCLUSIONS Results of this study indicate that selective brain cooling is an effective method of decreasing ICP in rats; however, the deeper hypothermia caused a greater decrease in ICP three hours after hypothermia induction.
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Affiliation(s)
- Abdullah Sadik Girisgin
- Department of Emergency Medicine, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Erdal Kalkan
- Department of Neurosurgery, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Ergin
- Department of Emergency Medicine, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Fatih Keskin
- Department of Neurosurgery, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Zerrin Defne Dundar
- Department of Emergency Medicine, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Sedat Kebapcioglu
- Department of Emergency Medicine, Medicine Faculty, Mevlana University, Konya, Turkey
| | - Sedat Kocak
- Department of Emergency Medicine, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Basar Cander
- Department of Emergency Medicine, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
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Dariolli R, Takimura CK, Campos CA, Lemos PA, Krieger JE. Development of a closed-artery catheter-based myocardial infarction in pigs using sponge and lidocaine hydrochloride infusion to prevent irreversible ventricular fibrillation. Physiol Rep 2014; 2:2/8/e12121. [PMID: 25168871 PMCID: PMC4246577 DOI: 10.14814/phy2.12121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The objectives of this study were to develop a robust, homogeneous, viable and inexpensive model of closed‐artery catheter‐based model of myocardial infarction (MI) in pigs without major cardiac dysfunction. Suitable animal models that mimic human cardiovascular conditions are of paramount importance to understand the effects of novel therapeutic strategies to improve tissue perfusion and prevent cardiac deterioration post‐MI. Pigs (N = 21, BW = 17 ± 1 kg) receiving continuous iv lidocaine hydrochloride were subjected to percutaneous intracoronary implant of foam sponge into the proximal left circumflex coronary artery. Intraprocedure mortality was 23.8%. ST segment elevation and increased serum Troponin T and CK‐MB were documented in all animals. Thirty days after occlusion, echocardiography (95% IC [9.3–12.4%]) and anatomopathological (95% CI [9.3–12.6%]) analyses confirmed a significant and reproducible MI. Taken together, we provide evidence for a suitable closed‐artery catheter‐based method to produce MI in pigs accompanied by tissue hypoperfusion and absence of overt heart failure. We provide evidence that an inexpensive and easily available material can be used to produce a robust and homogenous percutaneous closed‐artery model of MI in pigs, when associated with lidocaine hydrochloride use. Thirty days after occlusion, anatomopathological (95% IC [9.3–12.6%]) analyses confirmed a significant and reproducible MI accompanied by hypoperfusion and absence of overt heart failure.
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Affiliation(s)
- Rafael Dariolli
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Celso K Takimura
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos A Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro A Lemos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - José E Krieger
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
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Mauch J, Ringer SK, Spielmann N, Weiss M. Intravenous versus intramuscular epinephrine administration during cardiopulmonary resuscitation - a pilot study in piglets. Paediatr Anaesth 2013; 23:906-12. [PMID: 23551871 DOI: 10.1111/pan.12149] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Early epinephrine administration in cardiac arrest seems to be advantageous to achieve return of spontaneous circulation (ROSC). Because intravenous (i.v.) or intraosseous access is not always immediately available, this study compares efficacy of early intramuscular (i.m.) epinephrine administration with early and delayed i.v. epinephrine injection in an animal cardiac arrest model. METHODS Piglets anesthetized with sevoflurane were intoxicated by an i.v. ropivacaine infusion until circulatory arrest. After 1 min basic life support (chest compression and ventilation), epinephrine i.v. (10 μg·kg(-1), group IV) or epinephrine i.m. (100 μg·kg(-1), group IM) or normal saline (group NS) was applied. Further doses of epinephrine were given in group IV every 4 min and in group IM after 10 min if required. Twenty-one minutes after circulatory arrest, i.v. epinephrine - as necessary - was given to all animals. Thus, group NS represents late epinephrine administration. Outcomes were survival and time to ROSC. RESULTS Twenty-four pigs aged 19.5 (median, interquartile range 16-22) days, weighing 5.4 (5.0-5.7) kg were investigated. Total amount of ropivacaine administered was 8.9 (8.1-10.1) mg·kg(-1). Cardiac rhythm before starting CPR was pulseless electric activity and asystole in 15 and 9 pigs, respectively. Eight, seven, and four pigs survived in group IV, IM, and NS. Focusing on surviving animals, time to ROSC was 2, 4 and 19.5 min in group IV, IM, and NS. CONCLUSIONS Early i.m. epinephrine provided similar survival compared with early i.v. epinephrine and was superior to delayed epinephrine administration in resuscitation of ropivacaine-induced cardiac arrest in piglets.
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Affiliation(s)
- Jacqueline Mauch
- Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
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Henderson VC, Kimmelman J, Fergusson D, Grimshaw JM, Hackam DG. Threats to validity in the design and conduct of preclinical efficacy studies: a systematic review of guidelines for in vivo animal experiments. PLoS Med 2013; 10:e1001489. [PMID: 23935460 PMCID: PMC3720257 DOI: 10.1371/journal.pmed.1001489] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 06/13/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The vast majority of medical interventions introduced into clinical development prove unsafe or ineffective. One prominent explanation for the dismal success rate is flawed preclinical research. We conducted a systematic review of preclinical research guidelines and organized recommendations according to the type of validity threat (internal, construct, or external) or programmatic research activity they primarily address. METHODS AND FINDINGS We searched MEDLINE, Google Scholar, Google, and the EQUATOR Network website for all preclinical guideline documents published up to April 9, 2013 that addressed the design and conduct of in vivo animal experiments aimed at supporting clinical translation. To be eligible, documents had to provide guidance on the design or execution of preclinical animal experiments and represent the aggregated consensus of four or more investigators. Data from included guidelines were independently extracted by two individuals for discrete recommendations on the design and implementation of preclinical efficacy studies. These recommendations were then organized according to the type of validity threat they addressed. A total of 2,029 citations were identified through our search strategy. From these, we identified 26 guidelines that met our eligibility criteria--most of which were directed at neurological or cerebrovascular drug development. Together, these guidelines offered 55 different recommendations. Some of the most common recommendations included performance of a power calculation to determine sample size, randomized treatment allocation, and characterization of disease phenotype in the animal model prior to experimentation. CONCLUSIONS By identifying the most recurrent recommendations among preclinical guidelines, we provide a starting point for developing preclinical guidelines in other disease domains. We also provide a basis for the study and evaluation of preclinical research practice. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Valerie C. Henderson
- Studies of Translation, Ethics and Medicine (STREAM) Group, Biomedical Ethics Unit, Department of Social Studies of Medicine, McGill University, Montréal, Québec, Canada
| | - Jonathan Kimmelman
- Studies of Translation, Ethics and Medicine (STREAM) Group, Biomedical Ethics Unit, Department of Social Studies of Medicine, McGill University, Montréal, Québec, Canada
- * E-mail:
| | - Dean Fergusson
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeremy M. Grimshaw
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dan G. Hackam
- Division of Clinical Pharmacology, Department of Medicine, University of Western Ontario, London, Ontario, Canada
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Bangash MN, Kong ML, Pearse RM. Use of inotropes and vasopressor agents in critically ill patients. Br J Pharmacol 2012; 165:2015-33. [PMID: 21740415 DOI: 10.1111/j.1476-5381.2011.01588.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Inotropes and vasopressors are biologically and clinically important compounds that originate from different pharmacological groups and act at some of the most fundamental receptor and signal transduction systems in the body. More than 20 such agents are in common clinical use, yet few reviews of their pharmacology exist outside of physiology and pharmacology textbooks. Despite widespread use in critically ill patients, understanding of the clinical effects of these drugs in pathological states is poor. The purpose of this article is to describe the pharmacology and clinical applications of inotropic and vasopressor agents in critically ill patients.
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Affiliation(s)
- Mansoor N Bangash
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
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Cantrell CL, Hubble MW, Richards ME. Impact of Delayed and Infrequent Administration of Vasopressors on Return of Spontaneous Circulation during Out-of-Hospital Cardiac Arrest. PREHOSP EMERG CARE 2012; 17:15-22. [DOI: 10.3109/10903127.2012.702193] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Reynolds JC, Salcido DD, Menegazzi JJ. Conceptual models of coronary perfusion pressure and their relationship to defibrillation success in a porcine model of prolonged out-of-hospital cardiac arrest. Resuscitation 2012; 83:900-6. [PMID: 22266069 PMCID: PMC3360119 DOI: 10.1016/j.resuscitation.2012.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/12/2011] [Accepted: 01/02/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The amount of myocardial perfusion required for successful defibrillation after cardiac arrest is unknown. Coronary perfusion pressure (CPP) is a surrogate for myocardial perfusion. One limited clinical study identifies a threshold of 15 mmHg required for return of spontaneous circulation (ROSC). Our exploration of threshold and dose models of CPP during the initial bout of CPR indicates higher levels than previously demonstrated are required. CPP required for shock success throughout on-going resuscitation is unknown and other conceptual models of CPP have not been explored. HYPOTHESIS An array of conceptual models of CPP is associated with and predicts defibrillation success throughout resuscitation. METHODS Data from 6 porcine cardiac arrest studies were pooled. Mean and area under the curve (AUC) CPP were derived for 30-s epochs. Five conceptual models of CPP were analyzed: threshold, delta, cumulative delta, dose, and cumulative dose. Comparative statistics were performed with one-way ANOVA and two-tailed t-test. Regression models assessed CPP trends and prediction of ROSC. RESULTS For 316 defibrillation attempts in 124 animals, those resulting in ROSC (n=75) had significantly higher threshold, delta, cumulative delta, dose, and cumulative dose CPP than those without. All conceptual models except delta CPP had significantly different values across successive defibrillation attempts and all five models were significant predictors of ROSC, along with experimental design. CONCLUSIONS Threshold, delta, cumulative delta, dose, and cumulative dose CPP predict individual defibrillation success throughout resuscitation.
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Affiliation(s)
- Joshua C Reynolds
- University of Pittsburgh, Department of Emergency Medicine, Pittsburgh, PA 15261, United States.
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Rozanski EA, Rush JE, Buckley GJ, Fletcher DJ, Boller M. RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 4: Advanced life support. J Vet Emerg Crit Care (San Antonio) 2012; 22 Suppl 1:S44-64. [DOI: 10.1111/j.1476-4431.2012.00755.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - John E. Rush
- Cummings School of Veterinary Medicine; Tufts University; North Grafton; MA
| | - Gareth J. Buckley
- College of Veterinary Medicine, University of Florida; Gainesville; FL
| | - Daniel J. Fletcher
- College of Veterinary Medicine, Department of Clinical Sciences; Cornell University; Ithaca; NY
| | - Manuel Boller
- Department of Clinical Studies, School of Veterinary Medicine and the Department of Emergency Medicine, School of Medicine; Center for Resuscitation Science University of Pennsylvania; Philadelphia; PA
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Reynolds PS. Twenty years after: do animal trials inform clinical resuscitation research? Resuscitation 2011; 83:16-7. [PMID: 22085661 DOI: 10.1016/j.resuscitation.2011.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 10/27/2011] [Indexed: 10/15/2022]
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Larabee TM, Little CM, Raju BI, Cohen-Solal E, Erkamp R, Wuthrich S, Petruzzello J, Nakagawa M, Ayati S. A novel hands-free carotid ultrasound detects low-flow cardiac output in a swine model of pulseless electrical activity arrest. Am J Emerg Med 2011; 29:1141-6. [DOI: 10.1016/j.ajem.2010.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 05/06/2010] [Accepted: 05/24/2010] [Indexed: 11/24/2022] Open
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Nairn S. A critical realist approach to knowledge: implications for evidence-based practice in and beyond nursing. Nurs Inq 2011; 19:6-17. [DOI: 10.1111/j.1440-1800.2011.00566.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Varvarousi G, Xanthos T, Lappas T, Lekka N, Goulas S, Dontas I, Perrea D, Stefanadis C, Papadimitriou L. Asphyxial cardiac arrest, resuscitation and neurological outcome in a Landrace/Large-White swine model. Lab Anim 2011; 45:184-90. [PMID: 21508116 DOI: 10.1258/la.2011.010176] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The vast majority of laboratory studies on animals have focused on ventricular fibrillation (VF) and not on cardiac arrest (CA) resulting from asphyxia. The aim of this study was to develop a clinically relevant animal model in Landrace/Large-White swine of asphyxial CA resuscitated using the European Resuscitation Council guidelines. Survival and 24 h neurological outcome in terms of functional deficit were also evaluated. Asphyxial arrest was induced by clamping the endotracheal tube (ETT) in 10 Landrace/Large-White piglets. After 4 min of untreated arrest, resuscitation was initiated by unclamping the ETT, 100% oxygen mechanical ventilation, 2 min chest compressions and epinephrine administration. Advanced Life Support algorithm was followed. In case of restoration of spontaneous circulation, the animals were supported for one hour and then observed for 23 h. Coronary perfusion pressure was significantly higher in surviving animals (P < 0.001) during cardiopulmonary resuscitation. End-tidal CO(2) was significantly higher in the animals that survived than in non-surviving animals (P = 0.001). All of the animals were severely neurologically impaired 24 h after CA. This refined model of asphyxia CA is easily reproducible and may be used for pharmacological studies in CA.
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Affiliation(s)
- G Varvarousi
- Department of Experimental Surgery and Surgical Research, University of Athens, Medical School, 11527 Athens, Greece
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Doll H, Maegele M, Bohl J, Störkel S, Kipfmueller F, Schaefer U, Angelov D, Wirth S, Truebel H. Pharyngeal selective brain cooling is associated with reduced CNS cortical lesion after experimental traumatic brain injury in rats. J Neurotrauma 2011; 27:2245-54. [PMID: 20939694 DOI: 10.1089/neu.2010.1505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Therapeutic hypothermia (TH) is still being explored as a therapeutic option after traumatic brain injury (TBI) but clinical data has not supported its efficacy. Experimental approaches were promising, but clinical data did not support its efficacy in the treatment of TBI. A novel approach of pharyngeal selective brain cooling (pSBC), recently introduced by our group, has been accompanied by superior neurofunctional, sensorimotor, and cognitive outcomes. This work is now extended by data on histomorphological and physical outcomes after pSBC in a model of experimental TBI. Male Sprague-Dawley rats were subjected to lateral fluid-percussion (LFP) brain injury, and randomized to the following experimental groups: (1) TBI with pSBC, (2) TBI without pSBC, and (3) sham animals. On day post-injury (DPI) 14, the animals were sacrificed and their brains were harvested for immunohistochemistry using the following antibodies: (1) glial fibrillary acidic protein (GFAP), (2) neurofilament (NF), and (3) synaptophysin (SY). In pSBC animals brain temperature was selectively lowered to 33 ± 0.5°C within 15 min post-injury, and maintained for 180 min after induction, while keeping rectal temperatures at physiological levels. Animals that had undergone pSBC showed a significantly faster recovery of body weight starting on DPI 3, and had gained substantially more weight than TBI-only animals on DPI 14 (p < 0.001), indicating superior physical recovery. Areas of cortical damage were significantly smaller in pSBC animals compared to TBI-only animals (p < 0.01). pSBC was associated with preservation of cortical tissue ipsilateral to the lesion, and superior physical recovery after experimental TBI. These results complement earlier reports in which pSBC was associated with superior neurofunctional and cognitive outcomes using the same experimental model.
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Affiliation(s)
- Hinnerk Doll
- Institute for Research in Operative Medicine (IFOM), University of Witten-Herdecke, Cologne, Germany.
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Zuercher M, Kern KB, Indik JH, Loedl M, Hilwig RW, Ummenhofer W, Berg RA, Ewy GA. Epinephrine improves 24-hour survival in a swine model of prolonged ventricular fibrillation demonstrating that early intraosseous is superior to delayed intravenous administration. Anesth Analg 2011; 112:884-90. [PMID: 21385987 DOI: 10.1213/ane.0b013e31820dc9ec] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Vasopressors administered IV late during resuscitation efforts fail to improve survival. Intraosseous (IO) access can provide a route for earlier administration. We hypothesized that IO epinephrine after 1 minute of cardiopulmonary resuscitation (CPR) (an "optimal" IO scenario) after 10 minutes of untreated ventricular fibrillation (VF) cardiac arrest would improve outcome in comparison with either IV epinephrine after 8 minutes of CPR (a "realistic" IV scenario) or placebo controls with no epinephrine. METHODS Thirty swine were randomized to IO epinephrine, IV epinephrine, or placebo. Important outcomes included return of spontaneous circulation (ROSC), 24-hour survival, and 24-hour survival with good neurological outcome (cerebral performance category 1). RESULTS ROSC after 10 minutes of untreated VF was uncommon without administration of epinephrine (1 of 10), whereas ROSC was nearly universal with IO epinephrine or delayed IV epinephrine (10 of 10 and 9 of 10, respectively; P = 0.001 for either versus placebo). Twenty-four hour survival was substantially more likely after IO epinephrine than after delayed IV epinephrine (10 of 10 vs. 4 of 10, P = 0.001). None of the placebo group survived at 24 hours. Survival with good neurological outcome was more likely after IO epinephrine than after placebo (6 of 10 vs. 0 of 10, P = 0.011), and only 3 of 10 survived with good neurological outcome in the delayed IV epinephrine group (not significant versus either IO or placebo). CONCLUSION In this swine model of prolonged VF cardiac arrest, epinephrine administration during CPR improved outcomes. In addition, early IO epinephrine improved outcomes in comparison with delayed IV epinephrine.
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Affiliation(s)
- Mathias Zuercher
- The Sarver Heart Center at University of Arizona College of Medicine, Tucson, Arizona, USA.
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Affiliation(s)
- Jonathan Kimmelman
- Biomedical Ethics Unit, Department of Social
Studies of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alex John London
- Department of Philosophy, Carnegie Mellon
University, Pittsburgh, Pennsylvania, United States of America
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Boller M. Celebrating the 50th anniversary of cardiopulmonary resuscitation: from animals to humans…and back? J Vet Emerg Crit Care (San Antonio) 2010; 20:553-7. [PMID: 21166976 DOI: 10.1111/j.1476-4431.2010.00593.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The use of epinephrine during cardiac arrest has been advocated for decades and forms an integral part of the published guidelines. Its efficacy is supported by animal data, but human trial evidence is lacking. This is partly attributable to disparities in trial methodology. Epinephrine’s pharmacologic and physiologic effects include an increase in coronary perfusion pressure that is key to successful resuscitation. One possible explanation for the lack of epinephrine’s demonstrated efficacy in human trials of out-of-hospital cardiac arrest is the delay in its administration. A potential solution may be intraosseus epinephrine, which can be administered quicker. More importantly, it is the quality of the basic life support, early and uninterrupted chest compressions, early defibrillation and postresuscitation care that will provide the best chance of neurologically intact survival.
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Affiliation(s)
| | - Gordon A Ewy
- University of Arizona Sarver Heart Center, University of Arizona, Tucson, AZ, USA
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Reynolds JC, Salcido DD, Menegazzi JJ. Coronary perfusion pressure and return of spontaneous circulation after prolonged cardiac arrest. PREHOSP EMERG CARE 2010; 14:78-84. [PMID: 19947871 DOI: 10.3109/10903120903349796] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The amount of myocardial perfusion required for successful defibrillation after prolonged cardiac arrest is not known. Coronary perfusion pressure (CPP) is a surrogate for myocardial perfusion. One limited clinical study reported that a threshold of 15 mmHg was necessary for return of spontaneous circulation (ROSC), and that CPP was predictive of ROSC. A distinction between threshold and dose of CPP has not been reported. OBJECTIVE To test the hypothesis that swine achieving ROSC will have higher preshock mean CPP and higher preshock area under the CPP curve (AUC) than swine not attaining ROSC. METHODS Data from four similar swine cardiac arrest studies were retrospectively pooled. Animals had undergone 8-11 minutes of untreated ventricular fibrillation, 2 minutes of mechanical cardiopulmonary resuscitation (CPR), administration of drugs, and 3 more minutes of CPR prior to the first shock. Mean CPP +/- standard error of the mean (SEM) was derived from the last 20 compressions of each 30-second epoch of CPR and compared between ROSC/no-ROSC groups by repeated-measures analysis of variance (RM-ANOVA). AUC for all compressions delivered over the 5 minutes was calculated by direct summation and compared by Kruskal-Wallis test. Prediction of ROSC was assessed by logistic regression. RESULTS Throughout the first 5 minutes of CPR (n = 80), mean CPP +/- SEM was consistently higher in animals with ROSC (n = 63) (maximum CPP 41.2 +/- 0.6 mmHg) than animals with no ROSC (maximum CPP 20.1 +/- 0.3 mmHg) (p = 0.0001). Animals with ROSC received more total reperfusion (43.9 +/- 17.6 mmHg x 10(2)) than animals without ROSC (21.4 +/- 13.7 mmHg x 10(2)) (p < 0.001). Two regression models identified CPP (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.05, 1.18) and AUC (OR 1.10; 95% CI 1.05, 1.16) as predictors of ROSC. Experimental study also predicted ROSC in each model (OR 1.70; 95% CI 1.15, 2.50; and OR 1.59; 95% CI 1.12, 2.25, respectively). CONCLUSION Higher CPP threshold and dose are associated with and predictive of ROSC.
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Affiliation(s)
- Joshua C Reynolds
- Department of Emergency Medicine, University of Maryland, Baltimore, Maryland 21201, USA.
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Terlipressin versus adrenaline in an infant animal model of asphyxial cardiac arrest. Intensive Care Med 2010; 36:1248-55. [PMID: 20237762 DOI: 10.1007/s00134-010-1828-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The objective of this study was to compare the efficacy of terlipressin versus adrenaline in an experimental infant animal model of asphyxial cardiac arrest (ACA). DESIGN Prospective randomised animal study. SETTING Laboratory research department of a university hospital. METHODS Seventy-one, 2-month-old, mechanically ventilated piglets were investigated. ACA was induced by removal of mechanical ventilation. Resuscitation was performed by means of manual external chest compressions and mechanical ventilation (CC + V). After 3 min of CC + V, return of spontaneous circulation (ROSC) was observed in 11 animals. The 60 piglets without ROSC were then randomised to the four study groups: adrenaline standard dose (Asd): 0.01 mg/kg/3 min; adrenaline high dose (Ahd): first dose (0.01 mg/kg) and subsequent doses (0.1 mg/kg/3 min); terlipressin (T): 20 microg/kg/6 min; and adrenaline standard dose plus terlipressin (Asd + T). MEASUREMENTS AND RESULTS The relationship between haemodynamic (heart rate, blood pressure, ECG rhythm, cardiac index), respiratory (end-tidal CO(2), blood gas analysis) and tissue perfusion (gastric intramucosal pH, central, cerebral and renal saturation) parameters and ROSC was analysed. ROSC was achieved in three piglets treated with Asd (20%), four treated with Ahd (26.7%), one treated with T (6.7%) and seven treated with Asd + T (46.7%) (P = 0.099). ROSC was achieved in 43.1% of animals with pulseless electrical activity, 30.4% with asystole and none with ventricular fibrillation (P = 0.0001). CONCLUSION In this infant animal model of cardiac arrest, there was a non-significant trend towards better outcome when terlipressin was combined with adrenaline compared with the use of adrenaline or terlipressin alone.
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Rokutan H, Anker SD, Springer J. In vivomodels of cardiac diseases: application to drug development and screening. Expert Opin Drug Discov 2009; 5:65-78. [DOI: 10.1517/17460440903460299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Doll H, Truebel H, Kipfmueller F, Schaefer U, Neugebauer EAM, Wirth S, Maegele M. Pharyngeal selective brain cooling improves neurofunctional and neurocognitive outcome after fluid percussion brain injury in rats. J Neurotrauma 2009; 26:235-42. [PMID: 19196073 DOI: 10.1089/neu.2008.0741] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Therapeutic hypothermia (TH) after cardiac arrest reduces mortality and improves neurological outcome. Experimental TH after traumatic brain injury (TBI) indicated similar effects, but benefits were not reproducible in large clinical trials. Therefore, a novel approach of pharyngeal selective brain cooling (pSBC) was tested in respect to neurological outcome in a model of experimental TBI. Male Sprague-Dawley rats were subjected to lateral fluid percussion (LFP) brain injury and received pSBC for 3h post-injury. All animals were examined for neuromotor and sensorimotor dysfunction and coordination: before and after injury, and during recovery on day post-injury (DPI) 7 and 14 using (i) the standardized Composite Neuroscore (NS) test and (ii) the Rotarod test. Recovery of cognitive function was assessed on days 10-14 using (iii) the Barnes Circular Maze (BCM). In pSBC-animals, brain temperature was selectively lowered to 33 +/- 0.5 degrees C at 15 min post-injury, keeping rectal temperature at a physiologic level. All animals subjected to TBI via LFP showed an identical pattern of severe neurofunctional impairment at 24 h after injury. In the time course of the experiment, pSBC-animals showed superior neurofunctional recovery on DPI 7 (p = 0.03) and 14 (p = 0.002). Similarly, distance, time, and maximum speed on the Rota-Rod were significantly increased in pSBC-animals on DPI 7 (p < 0.01) and 14 (p < 0.01), as well as latency, distance, and mean number of errors in the BCM on DPI 14 (p < 0.01). The novel approach of pSBC was associated with improved neuromotor, sensormotor, and neurocognitive outcome after experimental TBI.
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Affiliation(s)
- Hinnerk Doll
- Institute for Research in Operative Medicine (IFOM), University of Witten-Herdecke, Cologne, Germany
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Rittenberger JC, Menegazzi JJ. Reply to letter: Increasing CPR duration prior to first defibrillation does not improve return of spontaneous circulation or survival in a swine model of prolonged ventricular fibrillation. Resuscitation 2009. [DOI: 10.1016/j.resuscitation.2008.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sattur S, Kern KB. Increasing CPR duration prior to first defibrillation does not improve return of spontaneous circulation or survival in a swine model of prolonged ventricular fibrillation. Resuscitation 2008; 80:382; author reply 382-3. [PMID: 19111376 DOI: 10.1016/j.resuscitation.2008.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 11/04/2008] [Indexed: 11/16/2022]
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Mader TJ. Prolonged cardiac arrest: A revised model of porcine ventricular fibrillation. Resuscitation 2008; 76:481-4. [DOI: 10.1016/j.resuscitation.2007.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 09/04/2007] [Indexed: 11/27/2022]
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In this issue. Resuscitation 2007. [DOI: 10.1016/j.resuscitation.2007.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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