Effects of Erythropoietin Administration on Adrenal Glands of Landrace/Large White Pigs after Ventricular Fibrillation

Aim.To evaluate the effects of erythropoietin administration on the adrenal glands in a swine model of ventricular fibrillation and resuscitation.Methods. Ventricular fibrillation was inducedviapacing wire forwarded into the right ventricle in 20 female Landrace/Large White pigs, allocated into 2 groups: experimental group treated with bolus dose of erythropoietin (EPO) and control group which received normal saline. Cardiopulmonary resuscitation (CPR) was performed immediately after drug administrationas perthe 2010 European Resuscitation Council (ERC) guidelines for Advanced Life Support (ALS) until return of spontaneous circulation (ROSC) or death. Animals who achieved ROSC were monitored, mechanically ventilated, extubated, observed, and euthanized. At necroscopy, adrenal glands samples were formalin-fixed, paraffin-embedded, and routinely processed. Sections were stained with hematoxylin-eosin.Results.Oedema and apoptosis were the most frequent histological changes and were detected in all animals in the adrenal cortex and in the medulla. Mild and focal endothelial lesions were also detected. A marked interindividual variability in the degree of the intensity of apoptosis and oedema at cortical and medullary level was observed within groups. Comparing the two groups, higher levels of pathological changes were detected in the control group. No significant difference between the two groups was observed regarding the endothelial changes.Conclusions. In animals exposed to ventricular fibrillation, EPO treatment has protective effects on the adrenal gland.

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The comparison of humeral intraosseous and intravenous administration of vasopressin on return of spontaneous circulation and pharmacokinetics in a hypovolemic cardiac arrest swine model

American Journal of Disaster Medicine ◽

10.5055/ajdm.2016.0245 ◽

2016 ◽

Vol 11 (4) ◽

pp. 237-242 ◽

Cited By ~ 1

Author(s):

Mark H. Wimmer, BSN ◽

Kenneth Heffner, BSN ◽

Michael Smithers, BSN ◽

Richard Culley, BSN ◽

Jennifer Coyner, PhD, CRNA ◽

...

Keyword(s):

Cardiac Arrest ◽

Analysis Of Variance ◽

Repeated Measures ◽

Maximum Concentration ◽

Life Support ◽

Spontaneous Circulation ◽

Control Group ◽

Swine Model ◽

Return Of Spontaneous Circulation ◽

Significant Difference

Introduction: The American Heart Association (AHA) recommends intravenous (IV) or intraosseous (IO) vasopressin in Advanced Cardiac Life Support (ACLS). Obtaining IV access in hypovolemic cardiac arrest patients can be difficult, and IO access is often obtained in these life threatening situations. No studies have been conducted to determine the effects of humeral IO (HIO) access with vasopressin in the return of spontaneous circulation (ROSC). Our study compared the kinetics of vasopressin and ROSC with HIO with IV access in the hypovolemic swine model.Methods: Twenty-two Yorkshire swine were divided into three groups: HIO (n = 7), IV (n = 8), and a control group (n = 7). The IV and HIO group received vasopressin and cardiopulmonary resuscitation (CPR), while the control group received only CPR. All subjects were exsanguinated 31 percent of their blood volume, placed in cardiac arrest, and resuscitated per ACLS. Subjects that achieved ROSC were then monitored for 20 minutes. Blood samples (10 mL) collected at 0.5, 1, 1.5, 2, 2.5, 3, and 4 minutes after vasopressin injection and analyzed for maximum concentration (Cmax) and time to maximum concentration (Tmax). Data were analyzed using a multivariate analysis of variance (MANOVA) and a Fisher's Exact Test.Results: ROSC was achieved in every subject that received vasopressin via the HIO route. Data analysis using a MANOVA pairwise comparison revealed no difference between mean Cmax (p = 0.601) and Tmax (p = 0.771) of vasopressin administered IV versus HIO routes. Analysis of the mean serum concentrations at time intervals using a repeated measures analysis of variance found no difference (p 0.05). A Fisher's Exact Test revealed no difference in rate of ROSC between HIO and IV groups (p 0.05). Odds ratio determined that there was a 33 times higher chance of survival among HIO subjects versus control (CPR and Defibrillation; p = 0.03) and no difference in the survivability of the HIO or IV groups (p = 0.52). Conclusion: The data from this study strongly suggest that there is no significant difference in ROSC, time to ROSC, hemodynamics, or pharmacokinetics between HIO vasopressin and IV vasopressin. This research reinforces current AHA guidelines recommending the use of HIO route early over delaying care awaiting IV access.

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Effect of Erythropoietin on Postresuscitation Renal Function in a Swine Model of Ventricular Fibrillation

BioMed Research International ◽

10.1155/2016/3567275 ◽

2016 ◽

Vol 2016 ◽

pp. 1-13

Author(s):

Charalampos Pantazopoulos ◽

Nicoletta Iacovidou ◽

Evangelia Kouskouni ◽

Paraskevi Pliatsika ◽

Apostolos Papalois ◽

...

Keyword(s):

Renal Function ◽

Ventricular Fibrillation ◽

Kidney Injury ◽

Kidney Damage ◽

Control Group ◽

Average Weight ◽

Swine Model ◽

Large White ◽

Mean Values ◽

Significant Difference

Purpose. To investigate the effect of EPO administration on postresuscitation renal function.Methods. Twenty-four female Landrace/Large-White piglets aged 10–15 weeks with average weight of19±2 kg were randomly assigned to 2 different groups of 12 subjects each. After the end of an 8-minute ventricular fibrillation, the control group (Group C) received saline as placebo, whereas the EPO group (Group E) received EPO 5000 U/kg. The animals were resuscitated according to the 2010 European Resuscitation Council Guidelines for Resuscitation.Results. Five animals (41.67%) from Group C and 11 animals (91.67%) from Group E achieved ROSC (p=0.027). Eight animals (66.67%, 5 surviving and 3 nonsurviving) from Group C suffered severe kidney damage or AKI compared to animals from Group E, in which none of the swine had evidence of severe kidney damage or AKI (p=0.001). There was a statistically significant difference in all tested biochemical markers between the two groups, as well as a positive correlation of creatinine with NGAL, L-FABP, and IL-18 (summed mean values’p=0.049, 0.01, and 0.004, resp.).Conclusions. Administration of EPO protected swine from postresuscitation acute kidney injury.

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The Resuscitative and Pharmacokinetic Effects of Humeral Intraosseous Vasopressin in a Swine Model of Ventricular Fibrillation

Prehospital and Disaster Medicine ◽

10.1017/s1049023x17000140 ◽

2017 ◽

Vol 32 (3) ◽

pp. 305-310 ◽

Cited By ~ 5

Author(s):

James M. Burgert ◽

Arthur D. Johnson ◽

Jose Garcia-Blanco ◽

Lawrence V. Fulton ◽

Michael J. Loughren

Keyword(s):

Ventricular Fibrillation ◽

Analysis Of Variance ◽

Repeated Measures ◽

Control Group ◽

Swine Model ◽

Maximum Plasma ◽

Publication Type ◽

Treatment Groups ◽

Significant Difference ◽

And Control

AbstractIntroductionThe American Heart Association (AHA; Dallas, Texas USA) and European Resuscitation Council (Niel, Belgium) cardiac arrest (CA) guidelines recommend the intraosseous (IO) route when intravenous (IV) access cannot be obtained. Vasopressin has been used as an alternative to epinephrine to treat ventricular fibrillation (VF).Hypothesis/ProblemLimited data exist on the pharmacokinetics and resuscitative effects of vasopressin administered by the humeral IO (HIO) route for treatment of VF. The purpose of this study was to evaluate the effects of HIO and IV vasopressin, on the occurrence, odds, and time of return of spontaneous circulation (ROSC) and pharmacokinetic measures in a swine model of VF.MethodsTwenty-seven Yorkshire-cross swine (60 to 80 kg) were assigned randomly to three groups: HIO (n=9), IV (n=9), and a control group (n=9). Ventricular fibrillation was induced and untreated for two minutes. Chest compressions began at two minutes post-arrest and vasopressin (40 U) administered at four minutes post-arrest. Serial blood specimens were collected for four minutes, then the swine were resuscitated until ROSC or 29 post-arrest minutes elapsed.ResultsFisher’s Exact test determined ROSC was significantly higher in the HIO 5/7 (71.5%) and IV 8/11 (72.7%) groups compared to the control 0/9 (0.0%; P=.001). Odds ratios of ROSC indicated no significant difference between the treatment groups (P=.68) but significant differences between the HIO and control, and the IV and control groups (P=.03 and .01, respectively). Analysis of Variance (ANOVA) indicated the mean time to ROSC for HIO and IV was 621.20 seconds (SD=204.21 seconds) and 554.50 seconds (SD=213.96 seconds), respectively, with no significant difference between the groups (U=11; P=.22). Multivariate Analysis of Variance (MANOVA) revealed the maximum plasma concentration (Cmax) and time to maximum concentration (Tmax) of vasopressin in the HIO and IV groups was 71753.9 pg/mL (SD=26744.58 pg/mL) and 61853.7 pg/mL (SD=22745.04 pg/mL); 111.42 seconds (SD=51.3 seconds) and 114.55 seconds (SD=55.02 seconds), respectively. Repeated measures ANOVA indicated no significant difference in plasma vasopressin concentrations between the treatment groups over four minutes (P=.48).ConclusionsThe HIO route delivered vasopressin effectively in a swine model of VF. Occurrence, time, and odds of ROSC, as well as pharmacokinetic measurements of HIO vasopressin, were comparable to IV.BurgertJM, JohnsonAD, Garcia-BlancoJ, FultonLV, LoughrenMJ. The resuscitative and pharmacokinetic effects of humeral intraosseous vasopressin in a swine model of ventricular fibrillation. Prehosp Disaster Med. 2017;32(3):305–310.

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A Comparison of Efficacy of Treatment and Time to Administration of Naloxone by BLS and ALS Providers

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19004527 ◽

2019 ◽

Vol 34 (04) ◽

pp. 350-355

Author(s):

Kenneth Nugent ◽

Patrick Matthews ◽

Jamie Gissendaner ◽

Mia Papas ◽

Deborah Occident ◽

...

Keyword(s):

Life Support ◽

Training Session ◽

Vital Signs ◽

Advanced Life Support ◽

The United States ◽

Control Group ◽

Opioid Overdose ◽

Respiratory Compromise ◽

Naloxone Administration ◽

Significant Difference

AbstractIntroduction:The administration of naloxone therapy is restricted by scope of practice to Advanced Life Support (ALS) in many Emergency Medical Services (EMS) systems throughout the United States. In Delaware’s two-tiered EMS system, Basic Life Support (BLS) often arrives on-scene prior to ALS, but BLS providers were not previously authorized to administer naloxone. Through a BLS naloxone pilot study, the researchers sought to evaluate BLS naloxone administration and timing compared to ALS.Hypothesis:After undergoing specialized training, BLS providers would be able to appropriately administer naloxone to opioid overdose patients in a more timely manner than ALS providers.Methods:This was a retrospective, observational study using data collected from February 2014 through May 2015 throughout a state BLS naloxone pilot program. A total of 14 out of 72 state BLS agencies participated in the study. Pilot BLS agencies attended a training session on the indications and administration of naloxone, and then were authorized to carry and administer naloxone. Researchers then compared vital signs and the time of BLS arrival to administration of naloxone by BLS and ALS. Data were analyzed using paired and independent sample t-tests, as well as chi-square, as appropriate.Results:A total of 131 incidents of naloxone administration were reviewed. Of those, 62 patients received naloxone by BLS (pilot group) and 69 patients received naloxone by ALS (control group). After naloxone administration, BLS patients showed improvements in heart rate (HR; P < .01), respiratory rate (RR; P < .01), and pulse oximetry (spO2; P < .01); ALS patients also showed improvement in RR (P < .01), and in spO2 (P = .005). There was no significant improvement in HR for ALS providers (P = .189).There was a significant difference in arrival time of BLS to the time of naloxone administration between the two groups, with shorter times in the BLS group compared to the ALS group (1.9 minutes versus 9.8 minutes; P < .01); BLS administration was 7.8 minutes faster when compared to ALS administration (95% CI, 6.2-9.3 minutes).Conclusions:Patients improved similarly and received naloxone therapy sooner when treated by BLS agencies carrying naloxone than those who awaited ALS arrival. All EMS systems should consider allowing BLS to carry and administer naloxone for an effective and potentially faster naloxone administration when treating respiratory compromise related to opiate overdose.

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Time for Reflection: The Balance between Repetition and Feedback in Resuscitation Training—A Randomised Controlled Trial

Advances in Emergency Medicine ◽

10.1155/2015/593625 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7

Author(s):

Kristian Krogh ◽

Morten Pilegaard ◽

Berit Eika

Keyword(s):

Randomised Controlled Trial ◽

Retention Test ◽

Life Support ◽

Controlled Trial ◽

Intervention Group ◽

Advanced Life Support ◽

Control Group ◽

Resuscitation Training ◽

Significant Difference ◽

Randomised Controlled

Background. The simulation literature widely agrees that the reflective learning phase after the simulation is equal to or perhaps of even greater importance than the actual simulated scenario in ensuring learning. Nevertheless, advanced life support (ALS) tends to have many simulated scenarios followed by short feedback sessions. The aim of this study was to compare the ability of two groups of novice learners to stay adherent to the ALS guidelines in their provision of ALS after they had received either 8 or 12 simulated resuscitation scenarios, both in 4 hours. Methods. This study was a randomised controlled trial. Participants were either randomised to the control group with 12 scenarios (15 minutes per scenario) with 5 minutes of feedback or the intervention group with 8 simulations (15 minutes per scenario) with 15 minutes of feedback. Results. There was no statistically significant difference in test scores between the intervention group and control group in the 1-week retention test (p=0.59) and the 12-week retention test (p=0.43). Conclusion. This study suggests that the lower number of repetitive ALS simulation scenarios does not diminish learning when the feedback is equally prolonged to ensure sufficient time for reflection.

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Abstract 12018: Cardiac Ultrasound Performed During Cardiac Arrest has Potential to Detect Pulmonary Embolism as a Reversible Cause of Cardiac Arrest when Compared to Hypoxia and Ventricular Fibrillation - A Randomized Porcine Study

Circulation ◽

10.1161/circ.132.suppl_3.12018 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Rasmus Aagaard ◽

Philip Caap ◽

Nicolaj C Hansson ◽

Morten T Bøtker ◽

Asger Granfeldt ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cardiac Arrest ◽

Ventricular Fibrillation ◽

Life Support ◽

Advanced Life Support ◽

Ultrasound Images ◽

Cardiac Ultrasound ◽

Pilot Studies ◽

Hypoxia Group ◽

Rhythm Analysis

Introduction: Survival from non-shockable cardiac arrest is unlikely unless a reversible cause is identified and treated. Guidelines state that ultrasound has the potential to identify reversible causes. Currently, ultrasonographic findings from patients with spontaneous circulation are extrapolated to patients in cardiac arrest. While right ventricular (RV) dilation is a finding normally associated with pulmonary embolism (PE), porcine studies have shown that RV dilation is also seen in ventricular fibrillation (VF) and severe hypoxia. No studies have investigated how causes of cardiac arrest affect RV size during resuscitation. Hypothesis: The RV diameter is larger during resuscitation of cardiac arrest caused by PE when compared to hypoxia and VF. Methods: Pigs were anesthetized and randomized to cardiac arrest induced by VF, hypoxia, or PE. Advanced life support (ALS) was preceded by 7 minutes of untreated cardiac arrest. Cardiac ultrasound images of the RV from a subcostal 5-chamber view were obtained during induction of cardiac arrest and ALS. The RV diameter was measured two centimeters from the aortic valve at end diastole. RV diameter at 3rd rhythm analysis was the primary endpoint. Based on pilot studies a sample size of 8 animals in each group was needed. Results: Eight animals were included in each group. RV diameter was not statistically different at baseline (mean (95%CI)) in VF: 19.8 (18.0-21.5) mm, hypoxia: 19.8 (16.6-22.9) mm, and PE: 21.8 (19.2-24.3) mm. During induction of cardiac arrest the RV diameter increased to 29.6 (27.3-31.9) mm in the hypoxia group and 38.0 (33.4-42.6) mm in the PE group (difference to baseline and between groups, both p<0.01). Induction of VF caused an immediate increase in the RV diameter to 25.0 (21.2-28.8) mm (difference to baseline p<0.01). At 3rd rhythm analysis, RV diameter was 32.4 (28.6-36.2) mm in the PE group, which was significantly larger than both the hypoxia group at 23.3 (19.5-27.0) mm and the VF group at 24.9 (22.2-27.5) mm (difference between groups p<0.01). Conclusions: Cardiac arrest due to VF, hypoxia, and PE all caused an increase in RV diameter. During resuscitation the RV was larger in PE compared to VF and hypoxia. Cardiac ultrasound thus has the potential to detect PE during resuscitation.

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Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

10.21203/rs.3.rs-1083706/v1 ◽

2021 ◽

Author(s):

Pramod Chandru ◽

Tatum Priyambada Mitra ◽

Nitesh Dutt Dhanekula ◽

Mark Dennis ◽

Adam Eslick ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Rescue Therapy ◽

A Priori ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Eligibility Criteria ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Poor Outcomes ◽

Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

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Effectiveness of Cryotherapy on Pain Reduction During Arteriovenous Fistula Puncture Among Patients Undergoing Hemodialysis

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i3.2646 ◽

2020 ◽

Vol 11 (3) ◽

pp. 4314-4317

Author(s):

Thamu Priyadharshini N T

Keyword(s):

Rating Scale ◽

Life Support ◽

Pain Reduction ◽

Control Group ◽

Pain Rating ◽

Av Fistula ◽

Numerical Pain Rating Scale ◽

Significant Difference ◽

Pain Rating Scale ◽

Experimental Group

Dialysis is performed as critical life support when the patient is suffering acute and chronic kidney failure. The study focus on to determine effectiveness of on pain reduction during AV fistula puncture among patients undergoing . The population comprised of patients in . Experimental Research design was utilized for this study. The investigators assess the pain on AV fistula puncture among the patients with the assistance of numerical pain rating scale, Sixty samples (30 experimental group and 30 control group)were selected by probability simple random (Numerical table method)sampling technique, the data was gathered through the Numerical Pain Rating scale and demographic variables. The pain on AV fistula puncture of the experimental group and control group were calculated by paired’ test for experimental group (‘t’ = 18) and in control group, (‘t’ =1.5). This proves that there is a significant difference in test and post test levels of pain on AV fistula puncture in the experimental group at 0.05 levels. It indicated that the given was effective. The implication of the findings indicated that given was effective for pain reduction during AV fistula puncture among patients. : , pain on AV fistula puncture, patients. implication of the findings indicated that given was effective for pain reduction during AV fistula puncture among patients.

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Effects of Microwave Oven Exposed Diet on Animal Weight and Testicular Tissue and Relative Role of Mentha Piperita

10.53350/pjmhs211592352 ◽

2021 ◽

Vol 15 (9) ◽

pp. 2352-2354

Author(s):

Kishwar Naheed ◽

Humaira Ali ◽

Fareeha Mushtaq ◽

Muhammad Saad Abdullah ◽

Maria Yousaf ◽

...

Keyword(s):

Weight Gain ◽

Testicular Tissue ◽

Microwave Oven ◽

Mentha Piperita ◽

Control Group ◽

Testis Weight ◽

Relative Role ◽

Protective Effects ◽

Trial Methodology ◽

Significant Difference

Background: Usage of electronic gadgets like microwave oven is increasing day by day that heats the food by exposing it to electromagnetic radiations which has many hazardous effects on human health including fertility. Aim: To find the effects of microwave oven exposed diet on weight and testis of mice along with protective effects of Mentha Piperita and Melatonin Study Design: Randomized control trial. Methodology: Adult male mice (n=32) were divided into four groups. Control group (G1) received standard pellets prepared for mice. Second group (G2) was given mice pellets exposed to microwave oven. Third group (G3) received Mentha Piperita leaf extract along with mice pellets exposed to microwave oven and the fourth group (G4) received oral melatonin along with pellets exposed to microwave oven. After experimental period, wt of each mice was again recorded and then mice were sacrificed. Data analyzed by SPSS 21.0v. Results: There was no statistically significant difference of weight gain of animals but there was significant reduction in weight of testis in group G2 but in G3 and G4 wt of the testis was close to control. Conclusion: It was concluded that microwave oven exposed diet had no significant effect on overall weight gain of the animal but it significantly reduced weight of the testis in group G2. However, Mentha Piperita and Melatonin both had ameliorative effects on the wt of the testicular tissue. Keywords: Mice, Testis, Weight, Mentha piperita and Melatonin

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The Effect of Thymol on Renal Toxicity Induced by Mercury Chloride in Rats

International Journal of Medical Laboratory ◽

10.18502/ijml.v8i3.7335 ◽

2021 ◽

Author(s):

Hamid Reza Jamshidi ◽

Faezeh Taheri

Keyword(s):

Mercuric Chloride ◽

Renal Toxicity ◽

Corn Oil ◽

Kidney Tissue ◽

Control Group ◽

Mercury Chloride ◽

Protective Effects ◽

Tissue Samples ◽

Significant Difference ◽

Anti Oxidant

Background and Aims: Mercuric chloride is highly toxic once absorbed into the bloodstream, especially the kidneys in which it is collected. Mercury chloride increases hydrogen peroxide and enhances the destruction of protective enzymes such as superoxide dismutase (SOD) and glutathione peroxidase (GPX), leading to oxidative stress. Besides, thymol has anti-oxidant effects and can increase the activity of SOD and GPX. This study aims to evaluate the efficacy of thymol on mercury chloride-induced toxicity. Materials and Methods: In this study, 30 rats, consisting of 6 groups of 5, were used. Control group receiving a single dose of 0.5 mg/kg mercuric chloride for 15 days, third, fourth, and fifth group received intraperitoneal injection of mercuric chloride at a dose of 0.5 mg/kg for 15 days plus thymol at a dose of 10, 30, 50 mg/kg. The sixth group received mercuric chloride at a dose of 0.5 mg/kg for 15 days plus thymol at 30 mg/kg per day for ten days. Results: Results showed a significant difference in the activity of catalase enzyme in kidney tissue samples test. According to the results of SOD, there is a significant difference between the group of corn oil and the group of mercury chloride and between the group of mercury chloride and the group that receives thymol at a dose of 10, 30, 50 mg/kg (p ≤ 0.05). Conclusions: It can be concluded that mercury chloride-induced kidney toxicity and thymol have anti-oxidant protective effects for SOD and GPX.

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