Resuscitation of Bupivicaine-Induced Cardiac Collapse

The local anesthetic, bupivacaine, is used to create a loss of sensation in a region of the body to provide analgesia or anesthesia. Military anesthetists routinely use this local anesthetic in austere environments due to its duration of action and availability. Unfortunately, the accidental injection of bupivacaine directly into a blood vessel has produced irreversible cardiac arrests resulting in death. There is no clearly identified effective treatment for bupivacaine-induced cardiac arrest in humans. The purpose of this study is to determine the efficacy of adding a lipid emulsion bolus and infusion to Advanced Cardiac Life Support directed interventions in treating bupivacaine-induced cardiovascular collapse in awake and unanesthetized sheep. The specific aims are: 1) to determine if the addition of a 4 ml/kg bolus of 20% lipid emulsion followed by a continuous infusion of 20% lipid emulsion at 0.5 ml/kg/min for 10 minutes increases the efficacy of Advanced Cardiac Life Support resuscitation of bupivacaine-induced cardiac arrest as indicated by rate of return to spontaneous circulation, time interval to return to spontaneous circulation, end-tidal carbon dioxide level, cardiac output, and mixed venous oxygen saturation; 2) to measure serum bupivacaine levels at 2, 5, and 10 minutes after bupivacaine-induced cardiac arrest and then every 10 minutes until termination of the experimental resuscitation; 3) to correlate serum bupivacaine levels with the measures of resuscitation efficacy. The proposed study design is a randomized, prospective, single blind, experimental design. The long-term objective of this research proposal is to provide essential data towards the development of an effective treatment for bupivacaine-induced cardiovascular collapse in humans. In accordance with the Tri-service Nursing Research Programs priorities, the proposed study will result in guiding clinical practice to provide safe and effective treatment for those military members in harms way.