Miao Yang, Edelheit Ari, Velmurugan Sathya, Borovnik-Lesjak Vesna, Radhakrishnan Jeejabai, Gazmuri Raúl J
Resuscitation Institute at Rosalind Franklin University of Medicine and Science North Chicago, Illinois, USA.
Resuscitation Institute at Rosalind Franklin University of Medicine and Science North Chicago, Illinois, USA ; Critical Care Medicine, Captain James A. Lovell Federal Health Care Center North Chicago, Illinois, USA.
Am J Transl Res. 2015 Mar 15;7(3):522-34. eCollection 2015.
Administration of 17β-estradiol has been shown to exert myocardial protective effects in hemorrhagic shock. We hypothesized that similar protective effects could help improve resuscitation from cardiac arrest. Three series of 18, 40, and 12 rats each, underwent ventricular fibrillation for 8 minutes followed by 8 minutes of chest compression and delivery of electrical shocks. In series-1, rats were randomized 1:1 to receive a bolus dose of 17β-estradiol (1 mg/kg) or 0.9% NaCl before chest compression; in series-2, rats were randomized 1:1:1:1 to receive a continuous infusion of 0.9% NaCl or a 17β-estradiol solution designed to attain a plasma level of 10(0), 10(2), or 10(4) nM during chest compression; and in series-3, rats were randomized 1:1 to receive a continuous infusion of 17β-estradiol to attain a plasma level of 10(2) nM or 0.9% NaCl during chest compression, providing inotropic support during the post-resuscitation interval using dobutamine infusion. 17β-estradiol failed to facilitate resuscitation in each of the 3 series. In series-1 and series-2, resuscitability and short-term survival was reduced in 17β-estradiol groups attaining statistical significance in series-2 when the three 17β-estradiol groups were combined (p = 0.035). In series-3, all rats were resuscitated and survived for 180 minutes aided by dobutamine which partially reversed post-resuscitation myocardial dysfunction but without additional benefits on myocardial function in the 17β-estradiol group. The present study failed to support a beneficial effect of 17β-estradiol for resuscitation from cardiac arrest and raised the possibility of detrimental cardiac effects compromising initial resuscitability and subsequent survival in a male rat model of ventricular fibrillation and closed chest resuscitation.
已表明给予17β-雌二醇可在失血性休克中发挥心肌保护作用。我们推测类似的保护作用可能有助于改善心脏骤停后的复苏。每组分别有18只、40只和12只大鼠，经历8分钟室颤，随后进行8分钟胸外按压并给予电击。在系列1中，大鼠在胸外按压前按1:1随机接受17β-雌二醇大剂量注射（1mg/kg）或0.9%氯化钠；在系列2中，大鼠按1:1:1:1随机接受0.9%氯化钠持续输注或一种17β-雌二醇溶液，该溶液旨在在胸外按压期间使血浆水平达到10(0)、10(2)或10(4)nM；在系列3中，大鼠按1:1随机接受17β-雌二醇持续输注以使血浆水平在胸外按压期间达到10(2)nM或0.9%氯化钠，并在复苏后期间使用多巴酚丁胺输注提供正性肌力支持。在这3个系列中，17β-雌二醇均未能促进复苏。在系列1和系列2中，17β-雌二醇组的复苏能力和短期存活率降低，在系列2中，当将3个17β-雌二醇组合并时具有统计学意义（p = 0.035）。在系列3中，所有大鼠在多巴酚丁胺的辅助下均复苏并存活180分钟，多巴酚丁胺部分逆转了复苏后心肌功能障碍，但在17β-雌二醇组中对心肌功能无额外益处。本研究未能支持17β-雌二醇对心脏骤停复苏有益的作用，并提出在雄性大鼠室颤和胸外心脏按压复苏模型中，有害的心脏效应可能会损害初始复苏能力和后续存活率。
