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Pyruvate‐Fortified Fluid Resuscitation Protects Left Ventricular Function and Metabolism During Hemorrhagic Shock and Hindlimb Ischemia
Author(s) -
Gurji Hunaid,
White Daniel W,
Hoxha Besim,
Sun Jie,
OlivenciaYurvati Albert H,
Mallet Robert T
Publication year - 2011
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.25.1_supplement.1098.6
Subject(s) - medicine , hemorrhagic shock , resuscitation , ischemia , cardiology , hindlimb , shock (circulatory) , ventricular function , anesthesia
Hemorrhagic shock imposes ischemia on the heart and other internal organs, but fluid resuscitation often fails to alleviate the resultant metabolic stress. We tested whether resuscitation with pyruvate‐enriched Ringer's solution (PR) afforded superior protection of myocardial energetics and electrophysiological performance vs. conventional Ringer's lactate (LR). Goats (~25kg) were bled to mean arterial pressure of 48±1 mmHg, subjected to hindlimb ischemia (HLI) with a tourniquet and femoral crossclamp, and then resuscitated with LR (n=8) or PR (n=8) (0.05 mmol/kg/h, i.v.) for 90 min; tourniquet and crossclamp were released at 60 min. Time controls (TC, n=8) underwent neither hemorrhage nor HLI. At 4 h post‐HLI, left ventricular myocardium was biopsied to measure creatine kinase (CK) activity and phosphocreatine (PCr) phosphorylation potential ([PCr]/{[Cr][P i ]}). Arterial pulse pressure, an index of systemic conductance, increased 54% after LR but only 15% after PR (P<0.05). Pro‐arrhythmic QTc dispersion was 25±6 ms post‐LR vs. 6.4±0.5 ms post‐PR (p<0.05). PR augmented phosphorylation potential (M −1 : 128±14) vs. LR (69±20; p<0.05). CK (U/mg protein) fell after LR (5.3±2.1) vs. TC (33.6±4.4), but PR preserved CK activity (28.5±5.4; p<0.02 vs. LR). Resuscitation with pyruvate maintained vascular resistance, myocardial energetics and electrocardiographic stability. Support: US DoD W911NF0910086