IntroductionThe combination of Adenosine (A), lidocaine (L) and Mg2+ (M) (ALM) has demonstrated cardioprotective and resuscitative properties in models of cardiac arrest and hemorrhagic shock. This study evaluates whether ALM also demonstrates organ protective properties in an endotoxemic porcine model.MethodsPigs (37 to 42 kg) were randomized into: 1) Control (n¿=¿8) or 2) ALM (n¿=¿8) followed by lipopolysaccharide infusion (1 ¿g¿kg-1¿h-1) for five hours. ALM treatment consisted of 1) a high dose bolus (A (0.82 mg/kg), L (1.76 mg/kg), M (0.92 mg/kg)), 2) one hour continuous infusion (A (300 ¿g¿kg-1 ¿min-1), L (600 ¿g¿kg-1 ¿min-1), M (336 ¿g¿kg-1 ¿min-1)) and three hours at a lower dose (A (240¿kg-1¿min-1), L (480 ¿g¿kg-1¿min-1), M (268 ¿g¿kg-1 ¿min-1)); controls received normal saline. Hemodynamic, cardiac, pulmonary, metabolic and renal functions were evaluated.ResultsALM lowered mean arterial pressure (Mean value during infusion period: ALM: 47 (95% confidence interval (CI): 44 to 50) mmHg versus control: 79 (95% CI: 75 to 85) mmHg, P <0.0001). After cessation of ALM, mean arterial pressure immediately increased (end of study: ALM: 88 (95% CI: 81 to 96) mmHg versus control: 86 (95% CI: 79 to 94) mmHg, P¿=¿0.72). Whole body oxygen consumption was significantly reduced during ALM infusion (ALM: 205 (95% CI: 189 to 221) ml oxygen/min versus control: 231 (95% CI: 215 to 247) ml oxygen/min, P¿=¿0.016). ALM treatment reduced pulmonary injury evaluated by PaO2/FiO2 ratio (ALM: 388 (95% CI: 349 to 427) versus control: 260 (95% CI: 221 to 299), P¿=¿0.0005). ALM infusion led to an increase in heart rate while preserving preload recruitable stroke work. Creatinine clearance was significantly lower during ALM infusion but reversed after cessation of infusion. ALM reduced tumor necrosis factor-¿ peak levels (ALM 7121 (95% CI: 5069 to 10004) pg/ml versus control 11596 (95% CI: 9083 to 14805) pg/ml, P¿=¿0.02).ConclusionALM infusion induces a reversible hypotensive and hypometabolic state, attenuates tumor necrosis factor-¿ levels and improves cardiac and pulmonary function, and led to a transient drop in renal function that was reversed after the treatment was stopped.