Dantrolene infusion during cardiopulmonary resuscitation improved the sustained return of spontaneous circulation compared to controls (85% vs 39%, P=0.02) in animal models of ventricular fibrillation.
Does dantrolene improve survival and calcium handling after ventricular fibrillation in animal models?
Dantrolene improves survival and hemodynamics after ventricular fibrillation in animal models by mitigating dysfunctional calcium cycling.
Absolute Event Rate: 85% vs 39%
p-value: p=0.02
BACKGROUND: Resistant ventricular fibrillation, refibrillation. and diminished myocardial contractility are important factors leading to poor survival after cardiac arrest. We hypothesized that dantrolene improves survival after ventricular fibrillation (VF) by rectifying the calcium dysregulation caused by VF. METHODS AND RESULTS: VF was induced in 26 Yorkshire pigs for 4 minutes. Cardiopulmonary resuscitation was then commenced for 3 minutes, and dantrolene or isotonic saline was infused at the onset of cardiopulmonary resuscitation. Animals were defibrillated and observed for 30 minutes. To study the effect of VF on calcium handling and its modulation by dantrolene, hearts from 14 New Zealand rabbits were Langendorff-perfused. The inducibility of VF after dantrolene administration was documented. Optical mapping was performed to evaluate diastolic spontaneous calcium elevations as a measure of cytosolic calcium leak. The sustained return of spontaneous circulation (systolic blood pressure ≥60 mm Hg) was achieved in 85% of the dantrolene group in comparison with 39% of controls (P=0.02). return of spontaneous circulation was achieved earlier in dantrolene-treated pigs after successful defibrillation (21 ± 6 s versus 181 ± 57 s in controls, P=0.005). The median number of refibrillation episodes was lower in the dantrolene group (0 versus 1, P=0.04). In isolated rabbit hearts, the successful induction of VF was achieved in 83% of attempts in controls versus 41% in dantrolene-treated hearts (P=0.007). VF caused diastolic calcium leaks in the form of spontaneous calcium elevations. Administration of 20 μmol/L dantrolene significantly decreased spontaneous calcium elevation amplitude versus controls. (0.024 ± 0.013 versus 0.12 ± 0.02 arbitrary unit 200-ms cycle length, P=0.001). CONCLUSIONS: Dantrolene infusion during cardiopulmonary resuscitation facilitates successful defibrillation, improves hemodynamics postdefibrillation, decreases refibrillation, and thus improves survival after cardiac arrest. The effects are mediated through normalizing VF-induced dysfunctional calcium cycling.
Zamiri et al. (2014) studied Ventricular fibrillation and cardiac arrest (n=40). Dantrolene vs. Isotonic saline / controls was evaluated on Sustained return of spontaneous circulation (systolic blood pressure ≥60 mm Hg) (p=0.02). Dantrolene infusion during cardiopulmonary resuscitation improved the sustained return of spontaneous circulation compared to controls (85% vs 39%, P=0.02) in animal models of ventricular fibrillation.