PMID- 24367539
OWN - NLM
STAT- MEDLINE
DCOM- 20141008
LR  - 20211021
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 8
IP  - 12
DP  - 2013
TI  - Combination of epinephrine with esmolol attenuates post-resuscitation myocardial 
      dysfunction in a porcine model of cardiac arrest.
PG  - e82677
LID - 10.1371/journal.pone.0082677 [doi]
LID - e82677
AB  - BACKGROUND: Recent experimental and clinical studies have indicated that the 
      beta-adrenergic effect of epinephrine significantly increases the severity of post 
      resuscitation myocardial dysfunction. The aim of the study was to investigate 
      whether the short-acting beta(1)-selective adrenergic blocking agent, esmolol, would 
      attenuate post resuscitation myocardial dysfunction in a porcine model of cardiac 
      arrest. METHODS AND RESULTS: After 8 min of untreated ventricular fibrillation 
      and 2 min of basic life support, 24 pigs were randomized to three groups (n = 8 
      per group), which received central venous injection of either epinephrine 
      combined with esmolol (EE group), epinephrine (EP group), or saline (SA group). 
      Hemodynamic status and blood samples were obtained at 0, 30, 60, 120, 240 and 360 
      min after return of spontaneous circulation (ROSC). Surviving pigs were 
      euthanatized at 24 h after ROSC, and the hearts were removed for analysis by 
      electron microscopy, Western blotting, quantitative real-time polymerase chain 
      reaction, and terminal deoxynucleotidyl transferase-mediated dUTP nick end 
      labeling (TUNEL) assay. Compared with the EP and SA groups, EE group had a better 
      outcome in hemodynamic function, (improved dp/dt maxima and minima and cardiac 
      output) (P<0.05), and improved oxygen metabolism (oxygen delivery and oxygen 
      consumption) (P<0.05), which suggesting that EE can protect myocardial tissue 
      from injury and improve post-resuscitation myocardial dysfunction. The protective 
      effect of EE also correlated with reducing cardiomyocyte apoptosis, evidenced by 
      reducing TUNEL-positive cells, increasing anti-apoptotic Bcl-2/Bax ratio and 
      suppression of caspase-3 activity in myocardium. CONCLUSIONS: Esmolol, a 
      short-acting beta(1)-selective adrenergic blocking agent, given during CPR has 
      significant effects on attenuating post resuscitation myocardial dysfunction. The 
      current study provides a potential pharmacologic target for post resuscitation 
      myocardial dysfunction.
FAU - Zhang, Qian
AU  - Zhang Q
AD  - Department of Emergency Medicine, Beijing Chao Yang Hospital, Capital Medical 
      University, Beijing, China.
FAU - Li, Chunsheng
AU  - Li C
AD  - Department of Emergency Medicine, Beijing Chao Yang Hospital, Capital Medical 
      University, Beijing, China.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20131218
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Adrenergic alpha-Agonists)
RN  - 0 (Adrenergic beta-1 Receptor Antagonists)
RN  - 0 (Drug Combinations)
RN  - 0 (Propanolamines)
RN  - MDY902UXSR (esmolol)
RN  - YKH834O4BH (Epinephrine)
SB  - IM
MH  - Adrenergic alpha-Agonists/*therapeutic use
MH  - Adrenergic beta-1 Receptor Antagonists/*therapeutic use
MH  - Animals
MH  - Cardiopulmonary Resuscitation
MH  - Drug Combinations
MH  - Epinephrine/administration & dosage/*therapeutic use
MH  - Heart Arrest/*drug therapy
MH  - Hemodynamics/drug effects/physiology
MH  - Myocardium/metabolism
MH  - Propanolamines/*therapeutic use
MH  - Swine
MH  - Ventricular Fibrillation/drug therapy
PMC - PMC3867387
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2013/12/25 06:00
MHDA- 2014/10/09 06:00
PMCR- 2013/12/18
CRDT- 2013/12/25 06:00
PHST- 2013/06/04 00:00 [received]
PHST- 2013/10/26 00:00 [accepted]
PHST- 2013/12/25 06:00 [entrez]
PHST- 2013/12/25 06:00 [pubmed]
PHST- 2014/10/09 06:00 [medline]
PHST- 2013/12/18 00:00 [pmc-release]
AID - PONE-D-13-23006 [pii]
AID - 10.1371/journal.pone.0082677 [doi]
PST - epublish
SO  - PLoS One. 2013 Dec 18;8(12):e82677. doi: 10.1371/journal.pone.0082677. 
      eCollection 2013.