Hemodynamic effects of IV sodium nitrite in hospitalized comatose survivors of out of hospital cardiac arrest

Dezfulian, Cameron; Olsufka, Michele; Fly, Deborah; Scruggs, Sue; Do, Rose; Maynard, Charles; Nichol, Graham; Kim, Francis

doi:10.1016/j.resuscitation.2017.11.055

Cited by 13 publications

(9 citation statements)

References 34 publications

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“…Further data from the same study have now been published in 11 patients (seven nitrite/four placebo) receiving 1 (n 5 3) or 9.6 mg (n 5 4) NaNO 2 after resuscitation from outof-hospital cardiac arrest. Only the higher dose was associated with significant elevation in plasma nitrite levels, and neither dose was associated with worsening hemodynamics, although no hard outcomes were reported, and the study finished without completing its planned third dose (14.5 mg NaNO 2 ) and was only able to recruit 11 patients into the study out of .450 out-ofhospital cardiac arrests in the 5 years that the study was open and recruiting (Dezfulian et al, 2018).…”

Section: F Nitrite and Nitrate In Metabolic Diseasesmentioning

confidence: 99%

The Noncanonical Pathway for In Vivo Nitric Oxide Generation: The Nitrate-Nitrite-Nitric Oxide Pathway

et al. 2020

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Section: F Nitrite and Nitrate In Metabolic Diseasesmentioning

confidence: 99%

The Noncanonical Pathway for In Vivo Nitric Oxide Generation: The Nitrate-Nitrite-Nitric Oxide Pathway

et al. 2020

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“…8,11,12 Human data on the effects of sodium nitrite during resuscitation are lacking; however, our group recently performed a small in-hospital study in which resuscitated OHCA patients received 1 or 9.6 mg IV sodium nitrite within 12 h after ROSC. 16 We found no significant effect of these nitrite doses given in the post resuscitation phase on blood pressure or heart rate. Determining whether the administration of sodium nitrite during active resuscitation of OHCA is associated with significant acute effects on hemodynamics was the primary goal of this study.…”

Section: Discussionmentioning

confidence: 51%

“…The 25 mg dose was chosen based on preliminary animal studies 11 and a small pilot study in patients hospitalized after OHCA 16 . Since the present study was designed as a phase 1 study, the protocol was designed to allow for nitrite dose adjustment if necessary.…”

Section: Methodsmentioning

confidence: 99%

Usefulness of Intravenous Sodium Nitrite During Resuscitation for the Treatment of Out-of-Hospital Cardiac Arrest

Kim

Dezfulian

Empey

et al. 2018

The American Journal of Cardiology

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It is hypothesized that intravenous (IV) sodium nitrite given during resuscitation of out-of-hospital cardiac arrest (OHCA) will improve survival. We performed a phase 1 open-label study of IV sodium nitrite given during resuscitation of 120 patents with OHCA from ventricular fibrillation or nonventricular fibrillation initial rhythms by Seattle Fire Department paramedics. A total of 59 patients received 25 mg (low) and 61 patients received 60 mg (high) of sodium nitrite during resuscitation from OHCA. Treatment effects were compared between high- and low-dose nitrite groups, and all patients in a concurrent local Emergency Medical Services registry of OHCA. Whole blood nitrite levels were measured in 97 patients. The rate of return of spontaneous circulation (48% vs 49%), rearrest in the field (15% vs 25%), use of norepinephrine (12% vs 12%), first systolic blood pressure (124 ± 32 vs 125 ± 38 mm Hg), survival to discharge (23.7% vs 16.4%), and neurologically favorable survival (18.6% vs 11.5%) were not significantly different in the low and high nitrite groups. There were no significant differences in these outcomes among patients who received IV nitrite compared with concurrent registry controls. We estimate that 60 mg achieves whole blood nitrite levels of 22 to 38 μM 10 minutes after administration, whereas 25 mg achieves a level of 9 to 16 μM 10 minutes after delivery. In conclusion, administration of IV nitrite is feasible and appears to be safe in patients with OHCA, permitting subsequent evaluation of the effectiveness of IV nitrite for the treatment of OHCA.

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“…Dezfulian et al conducted a single-center, randomized, double-blind pilot clinical study to determine the effect of low-dose (~9.6 mg) intravenous sodium nitrate, a donor of NO, on OHCA patients ( 92 ). The patients were eligible to be enrolled in this study if the patient was successfully resuscitated from non-traumatic CA and survived to the intensive care unit (ICU) admission.…”

Section: Recent Developments In Gas Research As Therapeutic Agents Fomentioning

confidence: 99%

Inhaled Gases as Therapies for Post–Cardiac Arrest Syndrome: A Narrative Review of Recent Developments

et al. 2021

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Despite recent advances in the management of post–cardiac arrest syndrome (PCAS), the survival rate, without neurologic sequelae after resuscitation, remains very low. Whole-body ischemia, followed by reperfusion after cardiac arrest (CA), contributes to PCAS, for which established pharmaceutical interventions are still lacking. It has been shown that a number of different processes can ultimately lead to neuronal injury and cell death in the pathology of PCAS, including vasoconstriction, protein modification, impaired mitochondrial respiration, cell death signaling, inflammation, and excessive oxidative stress. Recently, the pathophysiological effects of inhaled gases including nitric oxide (NO), molecular hydrogen (H2), and xenon (Xe) have attracted much attention. Herein, we summarize recent literature on the application of NO, H2, and Xe for treating PCAS. Recent basic and clinical research has shown that these gases have cytoprotective effects against PCAS. Nevertheless, there are likely differences in the mechanisms by which these gases modulate reperfusion injury after CA. Further preclinical and clinical studies examining the combinations of standard post-CA care and inhaled gas treatment to prevent ischemia–reperfusion injury are warranted to improve outcomes in patients who are being failed by our current therapies.

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Hemodynamic effects of IV sodium nitrite in hospitalized comatose survivors of out of hospital cardiac arrest

Abstract: Low dose sodium nitrite does not cause significant hemodynamic effect in patients with OHCA, which suggests that nitrite can be delivered safely in this critically ill patient population. Higher doses of sodium nitrite are necessary in order to achieve target serum level of 10μM.

Cited by 13 publications

References 34 publications

The Noncanonical Pathway for In Vivo Nitric Oxide Generation: The Nitrate-Nitrite-Nitric Oxide Pathway

The Noncanonical Pathway for In Vivo Nitric Oxide Generation: The Nitrate-Nitrite-Nitric Oxide Pathway

Usefulness of Intravenous Sodium Nitrite During Resuscitation for the Treatment of Out-of-Hospital Cardiac Arrest

Inhaled Gases as Therapies for Post–Cardiac Arrest Syndrome: A Narrative Review of Recent Developments

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