Pyruvate stabilizes electrocardiographic and hemodynamic function in pigs recovering from cardiac arrest

Abstract

Cardiac electromechanical dysfunction may compromise recovery of patients who are initially resuscitated from cardiac arrest, and effective treatments remain elusive. Pyruvate, a natural intermediary metabolite, energy substrate, and antioxidant, has been found to protect the heart from ischemia-reperfusion injury. This study tested the hypothesis that pyruvate-enriched resuscitation restores hemodynamic, metabolic, and electrolyte homeostasis following cardiac arrest. Forty-two Yorkshire swine underwent pacing-induced ventricular fibrillation and, after 6 min pre-intervention arrest, 4 min precordial compressions followed by transthoracic countershocks. After defibrillation and recovery of spontaneous circulation, the pigs were monitored for another 4 h. Sodium pyruvate or NaCl were infused i.v. (0.1 mmolÁkg À1 Ámin À1 ) throughout precordial compressions and the first 60 min recovery. In 8 of the 24 NaCl-infused swine, the first countershock converted ventricular fibrillation to pulseless electrical activity unresponsive to subsequent countershocks, but only 1 of 18 pyruvate-treated swine developed pulseless electrical activity (relative risk 0.17; 95% confidence interval 0.13-0.22). Pyruvate treatment also lowered the dosage of vasoconstrictor phenylephrine required to maintain systemic arterial pressure at 15-60 min recovery, hastened clearance of excess glucose, elevated arterial bicarbonate, and raised arterial pH; these statistically significant effects persisted up to 3 h after sodium pyruvate infusion, while infusion-induced hypernatremia subsided. These results demonstrate that pyruvate-enriched resuscitation achieves electrocardiographic and hemodynamic stability in swine during the initial recovery from cardiac arrest. Such metabolically based treatment may offer an effective strategy to support cardiac electromechanical recovery immediately after cardiac arrest.

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“…After 10 min CA, precordial compressions were administered at a rate of 100/min for 4 min, producing cerebral perfusion pressure of 69 AE 5 mmHg. 26 Transthoracic countershocks (200-300 J) were applied singly, with 30 s intervening CCR, until spontaneous cardiac electromechanical rhythm was reestablished. Sodium pyruvate or NaCl was infused intravenous (0.1 mmol/kg/min) during CCR and the first 60 min of recovery.…”

“…26 A pacing wire was inserted into the jugular venous cannula and advanced until it contacted the right ventricular endocardium, and the heart was arrested by pacing at 4 Hz. After 10 min CA, precordial compressions were administered at a rate of 100/min for 4 min, producing cerebral perfusion pressure of 69 AE 5 mmHg.…”

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“…Compared with them, pyruvate has multifactorial benefits because of its favorable properties associated with cellular function: enhancement of anoxia and/or hypoxia tolerance, antioxidative stress and anti-inflammation, and prevention of apoptosis in severe pathogenic insults. [3][4][5][6][7][8] Recently, compared with the bicarbonate-based ORS (WHO-ORS I, 331 mOsm/L), a novel pyruvate-based ORS (Pyr-ORS, pyruvate replaces equimolar bicarbonate in WHO-ORS I, 335 mOsm/L) showed its advantages. It enhanced intestinal absorption of sodium and water, improved visceral blood flow, and preserved multiple organs in rehydration of lethal shock in rodents.…”

Sodium Pyruvate Ameliorates Influenza A Virus InfectionIn Vivo

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