Effect of exogenous phosphocreatine on cardiomycytic apoptosis and expression of Bcl-2 and Bax after cardiopulmonary resuscitation in rats

BACKGROUND： Ischemia-reperfusion injury in the myocardium after cardiac arrest （CA）and cardiopulmonary resuscitation （CPR） is an important pathologic basis of post-cardiac arrestof syndrome （PCAS）, and apoptosis is one of the major mechanisms in myocardial ischemiareperfusioninjury. To lessen myocardial ischemia-reperfusion injury after cardiac arrest and CPR,it is important to reduce energy consumption and to increase energy supply in the myocardium.This study aimed to observe changes of cell apoptosis and expression of Bcl-2 and Bax proteinon the myocardium after CPR in rats, and the protective effects of different doses of exogenousphosphocreatine （creatine phosphate, CP） on them.METHODS： A total of 32 male adult Sprague-Dawley rats were randomly divided into 4 groups：control group （group A）, CPR group （group B）, low-dose CP group （group C, CP 0.5 g/kg at beginning ofCPR and 1.0 g/kg at 2 hours after CPR） and high-dose CP group （group D, CP 1.0 g/kg at beginning ofCPR and 2.0 g/kg at 2 hours after CPR）. Cardiac arrest was induced by asphyxiation and CPR startedat 7 minutes after asphyxiation in groups B, C and D. Myocardium samples were taken at 24 hoursafter CPR. Cardiomycytic apoptosis was detected by the TdT-mediated dUTP-biotin nick end labeling（TUNEL） method. The expression of Bcl-2 and Bax protein was measured by immunohistochemistry.RESULTS： Cardiomyocytic apoptosis index （AI） and expression of Bcl-2 and Bax proteinincreased more significantly in groups B, C and D than in group A （P〈0.01）, but Bcl-2/Bax ratiosignificantly decreased （P〈0.01）. Cardiomyocytic AI and expression of Bcl-2 and Bax proteindecreased more significantly in groups C and D than in group B （P〈0.01）, but Bcl-2/Bax ratioincreased more significantly （P〈0.01）. Cardiomyocytic AI and expression of Bcl-2 and Bax proteindecreased more signifi cantly in group D than in group C （P〈0.05）, but Bcl-2/Bax ratio increased moresignifi cantly （P〈0.05）.CONCLUSION： Exogenous phosphocreatine, especially at a large dose, could inhibitcardiomyocytic apoptosis and alleviate myocardial injury after CPR in rats.

Effects of Hemin on neuroglobin expression after cardiopulmonary resuscitation in rats

BACKGROUND： Despite a large amount of resuscitation research, the survival rate after cardiac arrest remains low, and brain injury is the key issue. Neuroglobin （NGB） is an oxygen-binding heme protein found in the brain with a protection role against ischemic-hypoxic brain injury. Hemin is an effective activator of neuroglobin. This study was undertaken to assess the effect of hemin on expression of neuroglobin （NGB） in the cerebral cortex, neuro-defi cit score （NDS） and pathological changes after cardiopulmonary resuscitation （CPR） in rats.METHODS： A total of 120 male Sprague-Dawley （SD） rats were randomly divided into a control group （A）, a CPR group （B） and a Hemin group （C）. The animal model of cardiac arrest （CA） induced by asphyxia and CPR was established. NGB expression in the cerebral cortex with immunohistochemistry, NDS and pathological changes in the cerebral cortex were examined at 3, 6, 12, 24 hours after recovery of spontaneous circulation （ROSC） in each group. Experimental data were treated as one-factor analysis of variance and the Tukey test.RESULTS： In comparison with group A, NGB expression was increased signifi cantly at 12 and 24 hours after ROSC （P〈0.05 or P〈0.01）, NDS was decreased signifi cantly at each time point after ROSC （P〈0.01）, and pathological changes were severe at each time point after ROSC in group B. In comparison with group A, NGB expression was increased signifi cantly at 6, 12, 24 hours after ROSC （P〈0.05 or P〈0.01）, NDS was decreased signifi cantly at 3, 6, 12 hours after ROSC （P〈0.01） in group C. In comparison with group B, NGB expression was increased signifi cantly at 12 and 24 hours after ROSC, NDS was increased signifi cantly at 12 and 24 hours after ROSC, and pathological changes were milder in group C.CONCLUSION： There were increased NGB expression in the cerebral cortex, decreased NDS, and severe pathological changes after CPR in rats. Hemin treatment up-regulated expression of NGB, improved NDS, mitigated pathological changes, and alleviated cerebral injury after CPR.

Factors influencing outcomes after cardiopulmonary resuscitation in emergency department

BACKGROUND:The outcome of cardiopulmonary resuscitation(CPR) may depend on a variety of factors related to patient status or resuscitation management.To evaluate the factors influencing the outcome of CPR after cardiac arrest(CA) will be conducive to improve the effectiveness of resuscitation.Therefore,a study was designed to assess these factors in the emergency department(ED) of a city hospital.METHODS:A CPR registry conforming to the Utstein-style template was conducted in the ED of the First Affiliated Hospital of Wenzhou Medical College from January 2005 to December 2011.The outcomes of CPR were compared in various factors groups.The primary outcomes were rated to return of spontaneous circulation(ROSC),24-hour survival,survival to discharge and discharge with favorable neurological outcomes.Univariate analysis and multivariable logistic regression analysis were performed to evaluate factors associated with survival.RESULTS:A total of 725 patients were analyzed in the study.Of these patients,187(25.8%) had ROSC,100(13.8%) survived for 24 hours,48(6.6%) survived to discharge,and 23(3.2%) survived to discharge with favorable neurologic outcomes.A logistic regression analysis demonstrated that the independent predictors of ROSC included traumatic etiology,first monitored rhythms,CPR duration,and total adrenaline dose.The independent predictors of 24-hour survival included traumatic etiology,cardiac etiology,first monitored rhythm and CPR duration.Previous status,cardiac etiology,first monitored rhythms and CPR duration were included in independent predictors of survival to discharge and neurologically favorable survival to discharge.CONCLUSIONS:Shockable rhythms,CPR duration ≤15 minutes and total adrenaline dose≤5 mg were favorable predictors of ROSC,whereas traumatic etiology was unfavorable.Cardiac etiology,shockable rhythms and CPR duration ?15 minutes were favorable predictors of 24-hour survival,whereas traumatic etiology was unfavorable.Cardiac etiology,shockable rhythms,CPR duration ≤15 minutes were favorable predictors of survival to discharge and neurologically favorable survival to discharge,but previous terminal illness or multiple organ failure(MOF) was unfavorable.