Carbon Monoxide Exerts Functional Neuroprotection After Cardiac Arrest Using Extracorporeal Resuscitation in Pigs

Deleterious consequences like acute kidney injury frequently occur upon successful resuscitation from cardiac arrest. Extracorporeal life support is increasingly used to overcome high cardiac arrest mortality. Carbon monoxide (CO) is an endogenous gasotransmitter, capable of reducing renal injury. In our study, we hypothesized that addition of CO to extracorporeal resuscitation hampers severity of renal injury in a porcine model of cardiac arrest. Hypoxic cardiac arrest was induced in pigs. Animals were resuscitated using a conventional [cardiopulmonary resuscitation (CPR)], an extracorporeal (E-CPR), or a CO-assisted extracorporeal (CO-E-CPR) protocol. CO was applied using a membrane-controlled releasing system. Markers of renal injury were measured, and histopathological analyses were carried out. We investigated renal pathways involving inflammation as well as apoptotic cell death. No differences in serum neutrophil gelatinase-associated lipocalin (NGAL) were detected after CO treatment compared with Sham animals (Sham 71 ± 7 and CO-E-CPR 95 ± 6 ng/mL), while NGAL was increased in CPR and E-CPR groups (CPR 135 ± 11 and E-CPR 124 ± 5 ng/mL; P < 0.05). Evidence for histopathological damage was abrogated after CO application. CO increased renal heat shock protein 70 expression and reduced inducible cyclooxygenase 2 (CPR: 60 ± 8; E-CPR 56 ± 8; CO-E-CPR 31 ± 3 µg/mL; P < 0.05). Caspase 3 activity was decreased (CPR 1,469 ± 276; E-CPR 1,670 ± 225; CO-E-CPR 755 ± 83 pg/mL; P < 0.05). Furthermore, we found a reduction in renal inflammatory signaling upon CO treatment. Our data demonstrate improved renal function by extracorporeal CO treatment in a porcine model of cardiac arrest. CO reduced proinflammatory and proapoptotic signaling, characterizing beneficial aspects of a novel treatment option to overcome high mortality.

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Carbon Monoxide Poisoning during Pregnancy: Presentation of a Rare Severe Case with Fetal Bladder Complications

Case Reports in Obstetrics and Gynecology ◽

10.1155/2015/687975 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Myriam Delomenie ◽

Floriane Schneider ◽

Joëlle Beaudet ◽

René Gabriel ◽

Nathalie Bednarek ◽

...

Keyword(s):

Carbon Monoxide ◽

Cardiac Arrest ◽

Pregnant Woman ◽

Brain Damage ◽

Carbon Monoxide Poisoning ◽

Severe Case ◽

Urinary Ascites ◽

Fetal Complications

Carbon monoxide poisoning during pregnancy is a rare and potentially serious condition. Fetal complications are uncommon, related to anoxic lesions. The severity of these complications does not depend on the level of maternal COHb. We report the case of a 22-year-old pregnant woman who at 30 weeks of gestation had carbon monoxide poisoning secondary to a fire in her home, complicated by cardiac arrest and severe fetal damage. The child had not brain damage, but presented bladder lesions not previously described, with urinary ascites complicating megacystis.

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Extracorporeal Resuscitation in Childhood Cardiac Arrest

AAP Grand Rounds ◽

10.1542/gr.24-4-49 ◽

2010 ◽

Vol 24 (4) ◽

pp. 49-49

Author(s):

V. Amula

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Resuscitation

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Carbon monoxide improves haemodynamics during extracorporeal resuscitation in pigs

Cardiovascular Research ◽

10.1093/cvr/cvz075 ◽

2019 ◽

Vol 116 (1) ◽

pp. 158-170 ◽

Cited By ~ 2

Author(s):

Jakob Wollborn ◽

Christoph Steiger ◽

Eva Ruetten ◽

Christoph Benk ◽

Fabian A Kari ◽

...

Keyword(s):

Carbon Monoxide ◽

Myocardial Dysfunction ◽

Myocardial Damage ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Flow Index ◽

Protective Effects ◽

Ventricular Ejection Fraction ◽

Sublingual Microcirculation ◽

Extracorporeal Resuscitation

Abstract Aims Heart disease of different aetiology remains the leading cause of cardiac arrest (CA). Despite efforts to improve the quality of cardiopulmonary resuscitation (CPR), subsequent myocardial and systemic damage after CA still present a major long-term burden. Low-dose carbon monoxide (CO) is known to exert protective effects in cardiovascular pathophysiology but clinical applications are challenged by unfavourable delivery modes. We tested the hypothesis that extracorporeal resuscitation (E-CPR) in combination with controlled fast onset CO delivery results in improved cardiac physiology and haemodynamics. Damage-associated molecular pattern (DAMP) signalling may be part of the molecular mechanism. Methods and results In an established porcine model, E-CPR was performed. While E-CPR leads to similar results as compared to a conventional CPR strategy, CO delivery in combination with E-CPR demonstrated significant cardioprotection. Cardiac performance analysis using echocardiography and thermodilution techniques showed a CO-dependent improved cardiac function compared to severe myocardial dysfunction in CPR and E-CPR (left ventricular ejection fraction: Sham 49 ± 5; CPR 26 ± 2; E-CPR 25 ± 2; CO-E-CPR 31 ± 4; P < 0.05). While sublingual microcirculation was significantly compromised in CPR and E-CPR, CO delivery demonstrated a significant improvement in microvascular function (microvascular flow index: Sham 2.9 ± 0.1; CPR 2.2 ± 0.1; E-CPR 1.8 ± 0.1; CO-E-CPR 2.7 ± 0.1; P < 0.01). Histological and serological myocardial damage markers were significantly reduced (hsTroponin-T Sham 0.01 ± 0.001; CPR 1.9 ± 0.2; E-CPR 3.5 ± 1.2; CO-E-CPR 0.5 ± 0.2 ng/mL; P < 0.05). DAMP signalling was decreased ipse facto leading to influence of cardioprotective heat shock and cyclooxygenase response. Conclusions CO treatment restores myocardial function and improves systemic macro- and microhaemodynamics in E-CPR through a reduction in DAMPs.

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357: CARBON MONOXIDE IMPROVES NEUROLOGIC OUTCOME IN A RAT MODEL OF CARDIAC ARREST

Critical Care Medicine ◽

10.1097/01.ccm.0000509035.26568.6d ◽

2016 ◽

Vol 44 (12) ◽

pp. 166-166

Author(s):

Peng Wang ◽

Lan Yao ◽

Lili Zhou ◽

Yuanshan Liu ◽

Zitong Huang

Keyword(s):

Carbon Monoxide ◽

Cardiac Arrest ◽

Rat Model ◽

Neurologic Outcome

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Anesthetic Management of Successful Extracorporeal Resuscitation After Six Hours of Cardiac Arrest Due to Severe Accidental Hypothermia

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2020.11.016 ◽

2020 ◽

Author(s):

R. Blasco Mariño ◽

E. Argudo ◽

M. Ribas ◽

X. Rogés Robledo ◽

I. Soteras Martínez ◽

...

Keyword(s):

Cardiac Arrest ◽

Anesthetic Management ◽

Accidental Hypothermia ◽

Extracorporeal Resuscitation

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Reply to Letter: Survival following cardiac arrest associated with carbon monoxide poisoning

Resuscitation ◽

10.1016/j.resuscitation.2009.06.014 ◽

2009 ◽

Vol 80 (9) ◽

pp. 1082-1083

Author(s):

Bryn E. Mumma ◽

David Shellenbarger ◽

Clifton W. Callaway ◽

Kenneth D. Katz ◽

Francis X. Guyette ◽

...

Keyword(s):

Carbon Monoxide ◽

Cardiac Arrest ◽

Carbon Monoxide Poisoning

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Evaluating the potential impact of an emergency department extracorporeal resuscitation (ECPR) program: a health records review

CJEM ◽

10.1017/cem.2019.472 ◽

2020 ◽

Vol 22 (3) ◽

pp. 375-378

Author(s):

Laura McDonald ◽

George Mastoras ◽

Michael Hickey ◽

Bernard McDonald ◽

Edmund S.H. Kwok

Keyword(s):

Emergency Department ◽

Cardiac Arrest ◽

Inclusion Criteria ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Health Records ◽

Initial Rhythm ◽

Bystander Cpr ◽

Academic Teaching Hospital ◽

Extracorporeal Resuscitation ◽

Refractory Cardiac Arrest

ABSTRACTObjectivesExtracorporeal cardiopulmonary resuscitation in refractory cardiac arrest (ECPR) is an emerging resuscitative therapy that has shown promising results for selected patients who may not otherwise survive. We sought to identify the characteristics of cardiac arrest patients presenting to our institution to begin assessing the feasibility of an ECPR program.MethodsThis retrospective health records review included patients aged 18–75 years old presenting to our academic teaching hospital campuses with refractory nontraumatic out-of-hospital or in-emergency department (ED) cardiac arrest over a 2-year period. Based on a scoping review of the literature, both “liberal” and “restrictive” ECPR criteria were defined and applied to our cohort.ResultsA total of 179 patients met inclusion criteria. Median age was 60 years, and patients were predominantly male (72.6%). The initial rhythm was ventricular tachycardia/ventricular fibrillation in 49.2%. The majority of arrests were witnessed (69.3%), with immediate bystander CPR performed on 53.1% and an additional 12% receiving CPR within 10 minutes of collapse. Median prehospital time was 40 minutes (interquartile range, 31–53.3). Two-thirds of patients (65.9%) were identified as having a reversible cause of arrest and favorable premorbid status was identified in nearly three quarters (74.3%). Our two sets of ECPR inclusion criteria revealed that 33 and 5 patients (liberal and restrictive criteria, respectively), would have been candidates for ECPR.ConclusionAt our institution, we estimate between 6% and 40% of ED refractory cardiac arrest patients would be candidates for ECPR. These findings suggest that the implementation of an ECPR program should be explored.

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