Effects of ATP-MgCl2 administration in hypovolemic dogs

BACKGROUND: The aim of the study was to evaluate the efficacy of ATP-MgCl2 on myocardial insufficiency associated with hypovolemic shock in dogs. We designed the study as a controlled randomized study. METHODS: Six mixed-breed dogs weighing 22 +/- 3 kg were included in the control group and 20 +/- 3 kg in the ATP-MgCl2 group. After the animals were anesthetized 40 ml/kg of blood was withdrawn in 15 minutes. Animals were observed for 45 minutes after removal of blood. Six animals received 45 ml/kg of lactated Ringer's solution and the other animals were treated with 45 ml/kg of lactated Ringer's solution and ATP-MgCl2. All measurements were made before removal of blood, 45 min after exsanguination and at 1 hour intervals for 3 hours. The following parameters were measured; systemic and pulmonary arterial pressures, pulmonary capillary wedge pressure, central venous pressure, cardiac output, rectal temperature, arterial pH, PCO2 and PO2 and mixed venous hemoglobin oxygen saturation. In addition blood samples were collected for the analysis of lactate and tumor necrosis factor (TNF) concentrations. RESULTS: After hemorrhage, cardiac index (CI) decreased significantly from 122 +/- 9 to 52 +/- 9 ml/kg/min in the control group (p < 0.0001) and from 124 +/- 11 ml/kg/min to 50 +/- 6 ml/kg/min in the ATP-MgCl2 group, respectively (p < 0.0001). After volume replacement, Cl was 93 +/- 6 ml/kg/min in the control group and 111 +/- 4 ml/kg/min in the ATP-MgCl2 group 3 hours after the onset of reinfusion, respectively (p < 0.05). TNF was 36 +/- 5 pg/ml in the control group and 21 +/- 3 pg/ml in the ATP-MgCl2 group (p < 0.05). Three hours after the onset of hemorrhagic shock, oxygen consumption and delivery were 126 +/- 14 and 206 +/- 19 ml/min in the control group and 198 +/- 16 and 305 +/- 27 ml/min in the ATP-MgCl2 group, respectively. At the same time point the oxygen extraction ratio was 0.49 +/- 0.04 in the control group and 0.61 +/- 0.03 in the ATP-MgCl2 group (p < 0.01). CONCLUSIONS: Hemorrhagic shock causes TNF release which may cause multiple organ failure. Organ dysfunction still persists even after the appropriate treatment. ATP-MgCl2 attenuates the release of TNF which may improve the adverse effects of hemorrhagic shock.