Survival and Neurologic Outcomes From Pharmacologic Peptide Administration During Cardiopulmonary Resuscitation of Pulseless Electrical Activity
Background Outcomes from cardiopulmonary resuscitation (CPR) following sudden cardiac arrest are suboptimal. Postresuscitation targeted temperature management has been shown to have benefit in subjects with sudden cardiac arrest due to ventricular fibrillation, but there are few data for outcomes fr...
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| Format: | Article |
| Language: | English |
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Wiley
2024-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.033371 |
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| author | Matt T. Oberdier Jing Li Daniel I. Ambinder Masahito Suzuki Ethan Tumarkin Sarah Fink Luca Neri Xiangdong Zhu Cody N. Justice Terry L. Vanden Hoek Henry R. Halperin |
| author_facet | Matt T. Oberdier Jing Li Daniel I. Ambinder Masahito Suzuki Ethan Tumarkin Sarah Fink Luca Neri Xiangdong Zhu Cody N. Justice Terry L. Vanden Hoek Henry R. Halperin |
| author_sort | Matt T. Oberdier |
| collection | DOAJ |
| description | Background Outcomes from cardiopulmonary resuscitation (CPR) following sudden cardiac arrest are suboptimal. Postresuscitation targeted temperature management has been shown to have benefit in subjects with sudden cardiac arrest due to ventricular fibrillation, but there are few data for outcomes from sudden cardiac arrest due to pulseless electrical activity. In addition, intra‐CPR cooling is more effective than postresuscitation cooling. Physical cooling is associated with increased protein kinase B activity. Therefore, our group developed a novel peptide, TAT‐PHLPP9c, which regulates protein kinase B. We hypothesized that when given during CPR, TAT‐PHLPP9c would improve survival and neurologic outcomes following pulseless electrical activity arrest. Methods and Results In 24 female pigs, pulseless electrical activity was induced by inflating balloon catheters in the right coronary and left anterior descending arteries for ≈7 minutes. Advanced life support was initiated. In 12 control animals, epinephrine was given after 1 and 3 minutes. In 12 peptide‐treated animals, 7.5 mg/kg TAT‐PHLPP9c was also administered at 1 and 3 minutes of CPR. The balloons were removed after 2 minutes of support. Animals were recovered and neurologically scored 24 hours after return of spontaneous circulation. Return of spontaneous circulation was more common in the peptide group, but this difference was not significant (8/12 control versus 12/12 peptide; P=0.093), while fully intact neurologic survival was significantly more common in the peptide group (0/12 control versus 11/12 peptide; P<0.00001). TAT‐PHLPP9c significantly increased myocardial nicotinamide adenine dinucleotide levels. Conclusions TAT‐PHLPP9c resulted in improved survival with full neurologic function after sudden cardiac arrest in a swine model of pulseless electrical activity, and the peptide shows potential as an intra‐CPR pharmacologic agent. |
| format | Article |
| id | doaj-art-e5b5001e241e49edadd1bff180471eef |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-e5b5001e241e49edadd1bff180471eef2025-08-20T02:26:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-07-01131310.1161/JAHA.123.033371Survival and Neurologic Outcomes From Pharmacologic Peptide Administration During Cardiopulmonary Resuscitation of Pulseless Electrical ActivityMatt T. Oberdier0Jing Li1Daniel I. Ambinder2Masahito Suzuki3Ethan Tumarkin4Sarah Fink5Luca Neri6Xiangdong Zhu7Cody N. Justice8Terry L. Vanden Hoek9Henry R. Halperin10Johns Hopkins University Baltimore MDUniversity of Illinois – Chicago Chicago ILJohns Hopkins University Baltimore MDJohns Hopkins University Baltimore MDJohns Hopkins University Baltimore MDJohns Hopkins University Baltimore MDJohns Hopkins University Baltimore MDUniversity of Illinois – Chicago Chicago ILUniversity of Illinois – Chicago Chicago ILUniversity of Illinois – Chicago Chicago ILJohns Hopkins University Baltimore MDBackground Outcomes from cardiopulmonary resuscitation (CPR) following sudden cardiac arrest are suboptimal. Postresuscitation targeted temperature management has been shown to have benefit in subjects with sudden cardiac arrest due to ventricular fibrillation, but there are few data for outcomes from sudden cardiac arrest due to pulseless electrical activity. In addition, intra‐CPR cooling is more effective than postresuscitation cooling. Physical cooling is associated with increased protein kinase B activity. Therefore, our group developed a novel peptide, TAT‐PHLPP9c, which regulates protein kinase B. We hypothesized that when given during CPR, TAT‐PHLPP9c would improve survival and neurologic outcomes following pulseless electrical activity arrest. Methods and Results In 24 female pigs, pulseless electrical activity was induced by inflating balloon catheters in the right coronary and left anterior descending arteries for ≈7 minutes. Advanced life support was initiated. In 12 control animals, epinephrine was given after 1 and 3 minutes. In 12 peptide‐treated animals, 7.5 mg/kg TAT‐PHLPP9c was also administered at 1 and 3 minutes of CPR. The balloons were removed after 2 minutes of support. Animals were recovered and neurologically scored 24 hours after return of spontaneous circulation. Return of spontaneous circulation was more common in the peptide group, but this difference was not significant (8/12 control versus 12/12 peptide; P=0.093), while fully intact neurologic survival was significantly more common in the peptide group (0/12 control versus 11/12 peptide; P<0.00001). TAT‐PHLPP9c significantly increased myocardial nicotinamide adenine dinucleotide levels. Conclusions TAT‐PHLPP9c resulted in improved survival with full neurologic function after sudden cardiac arrest in a swine model of pulseless electrical activity, and the peptide shows potential as an intra‐CPR pharmacologic agent.https://www.ahajournals.org/doi/10.1161/JAHA.123.033371Akt pathwaycardiac arrestcoolingdrugpharmaceuticTAT‐PHLPP9c |
| spellingShingle | Matt T. Oberdier Jing Li Daniel I. Ambinder Masahito Suzuki Ethan Tumarkin Sarah Fink Luca Neri Xiangdong Zhu Cody N. Justice Terry L. Vanden Hoek Henry R. Halperin Survival and Neurologic Outcomes From Pharmacologic Peptide Administration During Cardiopulmonary Resuscitation of Pulseless Electrical Activity Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease Akt pathway cardiac arrest cooling drug pharmaceutic TAT‐PHLPP9c |
| title | Survival and Neurologic Outcomes From Pharmacologic Peptide Administration During Cardiopulmonary Resuscitation of Pulseless Electrical Activity |
| title_full | Survival and Neurologic Outcomes From Pharmacologic Peptide Administration During Cardiopulmonary Resuscitation of Pulseless Electrical Activity |
| title_fullStr | Survival and Neurologic Outcomes From Pharmacologic Peptide Administration During Cardiopulmonary Resuscitation of Pulseless Electrical Activity |
| title_full_unstemmed | Survival and Neurologic Outcomes From Pharmacologic Peptide Administration During Cardiopulmonary Resuscitation of Pulseless Electrical Activity |
| title_short | Survival and Neurologic Outcomes From Pharmacologic Peptide Administration During Cardiopulmonary Resuscitation of Pulseless Electrical Activity |
| title_sort | survival and neurologic outcomes from pharmacologic peptide administration during cardiopulmonary resuscitation of pulseless electrical activity |
| topic | Akt pathway cardiac arrest cooling drug pharmaceutic TAT‐PHLPP9c |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.033371 |
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