Supplement of Lipid Emulsion to Epinephrine Improves Resuscitation Outcomes of Asphyxia-Induced Cardiac Arrest in Aged Rats

Figures & data

Table 1 Baseline Values of Weight, Blood Gas Values and Hemodynamic Metrics for Control, LCT and LCT/MCT Groups in Experiment A

	Control (n=22)	LCT (n=22)	LCT/MCT (n=22)
Weight, g	574±20	574±17	579±15
pH	7.40±0.03	7.40±0.03	7.40±0.04
PO2, mmHg	124±13	125±8	123±10
PCO2, mmHg	40±3	40±3	40±3
HCO3^−, mmol/L	23.4±1.3	24.7±2.0	24.6±1.7
BE, mmol/L	−0.3±1.5	−0.4±1.6	0.1±1.2
Lactate, mmol/L	1.2±0.6	1.1±0.6	1.3±0.6
HR, beat/min	355±21	346±18	345±16
MAP, mmHg	90±4	91±6	90±6
RPP, mmHg*beat/min	43595±3035	42928±3458	41939±2671

Notes: Baseline values showed no difference among the three groups; All values are mean ± SD.

Abbreviations: BE, base excess, HR, heart rate; MAP, mean arterial pressure; RPP, heart rate pressure product.

Table 2 Baseline Values of Weight, Hemodynamic Metrics for Control _0-120, LCT _0-120 and LCT/MCT _0-120 Groups in Experiment B

	Weight (g)	HR (Beat/Min)	MAP (mmHg)	RPP (mmHg*Beat/Min)
Control 0	568±16	356±18	91±5	43562±3034
Control 20	572±22	346±12	89±6	41452±3829
Control 40	565±17	352±20	93±7	42364±2980
Control 60	574±16	356±18	90±5	43212±2943
Control 80	578±22	348±14	91±6	41962±3003
Control 100	576±14	355±21	91±5	41879±2993
Control 120	568±17	345±23	90±6	42892±2894
LCT 0	573±13	350±17	91±5	41864±2653
LCT 20	573±13	351±19	89±6	40873±3634
LCT 40	569±12	354±16	94±5	41682±3213
LCT 60	570±21	358±24	91±9	42751±3034
LCT 80	570±18	348±14	93±5	41893±3123
LCT 100	575±20	349±16	91±7	42421±3064
LCT 120	567±14	348±17	90±8	41985±2519
LCT/MCT 0	571±17	345±15	91±5	43416±3328
LCT/MCT 20	572±16	348±16	92±5	41933±3274
LCT/MCT 40	573±18	349±17	91±6	39893±3452
LCT/MCT 60	578±19	348±21	90±8	39989±3246
LCT/MCT 80	570±13	352±17	88±7	40472±3122
LCT/MCT 100	571±12	351±19	89±6	40321±3004
LCT/MCT 120	569±14	357±13	93±8	42783±3123

Notes: Baseline values showed no difference among the 21 groups; All values are mean ± SD.

Abbreviations: HR, heart rate; MAP, mean arterial pressure; RPP, heart rate pressure product.

Table 3 Baseline Values of Blood Gas Values for Control _0-120, LCT _0-120 and LCT/MCT _0-120 Groups in Experiment B

	pH	PO2 (mmHg)	PCO2 (mmHg)	HCO3^− (mmol/L)	BE (mmol/L)	Lactate (mmol/L)
Control 0	7.40±0.05	120±9	40±4	23.5±1.9	0.1±1.5	0.9±0.7
Control 20	7.38±0.03	126±11	40±2	24.6±1.3	−0.3±1.2	1.6±0.6
Control 40	7.41±0.02	125±14	38±6	23.7±2.1	−0.2±1.6	0.8±0.5
Control 60	7.39±0.03	129±14	41±3	24.5±1.3	0.2±1.2	1.4±0.7
Control 80	7.42±0.04	118±11	40±3	23.3±1.6	0.4±1.1	1.2±0.4
Control 100	7.38±0.03	123±8	39±2	22.9±2.2	−0.1±0.9	1.0±0.6
Control 120	7.41±0.04	125±7	41±2	23.5±1.9	0.2±1.3	1.3±0.8
LCT 0	7.40±0.05	124±14	39±3	22.5±1.7	0.9±1.1	1.1±0.8
LCT 20	7.40±0.05	119±12	41±2	24.9±1.5	−0.2±1.8	1.6±0.7
LCT 40	7.38±0.03	121±9	39±3	24.2±1.4	−0.4±1.3	1.0±0.4
LCT 60	7.40±0.06	122±10	40±2	24.7±1.1	0.5±1.6	1.5±0.6
LCT 80	7.39±0.04	125±11	39±3	23.8±1.5	−0.8±1.2	1.2±0.8
LCT 100	7.38±0.03	127±7	41±3	23.7±1.2	0.4±1.5	0.9±0.6
LCT 120	7.41±0.04	124±15	40±2	24.1±1.5	0.3±1.2	1.2±0.9
LCT/MCT 0	7.39±0.03	123±9	39±3	24.5±1.4	0.4±1.3	1.2±0.7
LCT/MCT 20	7.41±0.06	128±11	39±2	24.5±1.3	−0.5±1.1	1.3±0.6
LCT/MCT 40	7.40±0.04	122±8	40±2	23.1±1.7	0.2±1.2	1.1±0.9
LCT/MCT 60	7.39±0.02	124±11	40±3	23.9±2.1	0.4±1.3	1.3±0.4
LCT/MCT 80	7.41±0.03	116±12	39±3	23.6±2.0	−0.1±1.6	1.0±0.7
LCT/MCT 100	7.37±0.06	122±6	40±3	23.9±1.6	−0.3±1.1	1.4±0.9
LCT/MCT 120	7.37±0.03	129±12	39±2	24.1±1.9	−0.2±1.4	0.9±0.6

Notes: Baseline values showed no difference among the 21 groups; All values are mean ± SD.

Abbreviations: PO₂, partial pressure of oxygen; PCO₂, partial pressure of carbon dioxide; HCO₃⁻, bicarbonate radical; BE, base excess.

Table 4 Resuscitation Outcomes for Control, LCT and LCT/MCT Groups in Experiment A

	Control (n=22)	LCT (n=22)	LCT/MCT (n=22)
Time to CA, seconds	105±18	107±15	104±16
Time to first heartbeat, seconds	59±13	55±11	60±15
Time to ROSC, seconds	113±36	78±20**	73±16^†††
Rate of ROSC, %	50.0% (11)	72.7% (17)	77.3% (17)
Mortality after ROSC, %	27.3% (3)	5.9% (1)	0 (0)
Survival rate, %	36.4% (8)	72.7% (16)*	77.3% (17)^†
Epinephrine cumulative dose, μg/kg	20 (20,20)	20 (20,20)	20 (10,20)

Notes: The Control, LCT and LCT/MCT groups displayed differences in time to ROSC (P<0.001); Control group vs LCT group, P=0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=1.000. The Control, LCT and LCT/MCT groups displayed differences in survival rate (P=0.012); Control group vs LCT group, P=0.033; Control group vs LCT/MCT group, P=0.014; LCT group vs LCT/MCT group, P=1.000. No significant differences were demonstrated among the three groups in time to CA, time to first heartbeat, rate of ROSC, mortality after ROSC or epinephrine cumulative dose. Normal data are mean ± SD, whereas non-normal data are median and interquartile values. *Control group vs LCT group, ^†Control group vs LCT/MCT group. *P<0.05, ^†P<0.05, **P<0.01, ^†††P<0.001.

Abbreviations: ROSC, return of spontaneous circulation; CA, cardiac arrest.

Figure 1 Continued.

Figure 1 Hemodynamic parameters for all rats that survived to 120 minutes in experiment A.

Notes: Data are presented as mean ± SD. (A) MAP vs time for rats during the 120-minute observation period after onset of resuscitation. Significant differences were demonstrated among the three groups in MAP during 120 minutes (P<0.001). The LCT and LCT/MCT groups produced superior MAP compared with the Control group (Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), and the LCT/MCT group produced superior MAP compared with the LCT group (LCT group vs LCT/MCT group, P=0.001). Significant differences were demonstrated among the three groups in MAP at 2 (P=0.037; Control group vs LCT group, P=0.038), 4 (P=0.018; LCT group vs LCT/MCT group, P=0.018), 10 (P<0.001; Control group vs LCT group, P=0.005; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 20 (P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 30 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 40 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 50 (P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 60 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 70 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 80 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 90 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 100 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 110 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001) and 120 minutes (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001). (B) HR vs time for rats during the 120-minute observation period after onset of resuscitation. Significant differences were demonstrated among the three groups in HR during 120 minutes (P<0.001). The LCT and LCT/MCT groups produced superior HR compared with the Control group (Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), and the LCT/MCT group produced superior HR compared with the LCT group (LCT group vs LCT/MCT group, P=0.004). Significant differences were demonstrated among the three groups in HR at 4 (P<0.001; Control group vs LCT group, P=0.001; Control group vs LCT/MCT group, P<0.001), 6 (P=0.024; LCT group vs LCT/MCT group, P=0.020), 20 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.027), 30 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.013), 40 (P<0.001; Control group vs LCT group, P=0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 50 (P<0.001; Control group vs LCT group, P=0.002; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 60 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 70 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 80 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.030), 90 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 100 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 110 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001) and 120 minutes (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001). (C) RPP vs time for rats during the 120-minute observation period after onset of resuscitation. Significant differences were demonstrated among the three groups in RPP during 120 minutes (P<0.001). The LCT and LCT/MCT groups produced superior RPP compared with the Control group (Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), and the LCT/MCT group produced superior RPP compared with the LCT group (LCT group vs LCT/MCT group, P<0.001). Significant differences were demonstrated among the three groups in RPP at 4 (P<0.001; Control group vs LCT group, P=0.002; Control group vs LCT/MCT group, P=0.019), 6 (P=0.024; Control group vs LCT/MCT group, P=0.016; LCT group vs LCT/MCT group, P=0.016), 10 (P<0.001; Control group vs LCT group, P=0.002; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.001), 20 (P<0.001; Control group vs LCT group, P=0.023; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 30 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 40 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 50 (P<0.001; Control group vs LCT group, P=0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 60 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.037), 70 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 80 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.026), 90 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 100 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 110 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001) and 120 minutes (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001). (D) RPP recovery ratio at 20, 40, 60, 80, 100 and 120 minutes. Significant differences were demonstrated among the three groups in RPP recovery ratio at 20 (P<0.001), 40 (P<0.001), 60 (P<0.001), 80 (P<0.001), 100 (P<0.001) and 120 minutes (P<0.001). The LCT/MCT group had higher RPP recovery ratios compared with the Control group at 20 (P<0.001), 40 (P<0.001), 60 (P<0.001), 80 (P<0.001), 100 (P<0.001) and 120 minutes (P<0.001). The LCT group had higher RPP recovery ratios compared with the Control group at 40 (P=0.001), 60 (P<0.001), 80 (P<0.001), 100 (P<0.001) and 120 minutes (P<0.001). The LCT/MCT group had higher RPP recovery ratios compared with the LCT group at 20 (P<0.001), 40 (P<0.001), 60 (P=0.023) and 80 minutes (P=0.021). *P<0.05, **P<0.01, ***P<0.001.

Abbreviations: MAP, mean arterial pressure; HR, heart rate; RPP, heart rate pressure product.

Figure 2 CPP vs time for rats that survived to 120 minutes in experiment A.

Notes: Data are presented as mean ± SD. Significant differences were demonstrated among the three groups during 120 minutes (P<0.001). The LCT and LCT/MCT groups produced superior CPP compared with the Control group (Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001). No significant difference was demonstrated between the LCT and the LCT/MCT group in CPP. Significant differences were demonstrated among the three groups in CPP at 2 (P=0.001; Control group vs LCT group, P=0.001; Control group vs LCT/MCT group, P=0.039), 4 (P=0.041; LCT group vs LCT/MCT group, P=0.037), 10 (P=0.011; Control group vs LCT group, P=0.033; Control group vs LCT/MCT group, P=0.011; LCT group vs LCT/MCT group, P<0.001), 20 (P<0.001; Control group vs LCT/MCT group, P=0.001; LCT group vs LCT/MCT group, P=0.008), 30 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 40 (P<0.001; Control group vs LCT group, P=0.014; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 50 (P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P<0.001), 60 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 70 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 80 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 90 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 100 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001), 110 (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001) and 120 minutes (P<0.001; Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001). *P<0.05, **P<0.01, ***P<0.001.

Abbreviation: CPP, coronary perfusion pressure.

Table 5 Blood Gas Values and Hemodynamic Metrics for Control, LCT and LCT/MCT Groups 120 Minutes and 72 Hours After Onset of Resuscitation in Experiment A

	Control	LCT	LCT/MCT
At 120 Minutes
pH	7.19±0.07	7.26±0.07	7.32±0.08^††
PO2, mmHg	153±28	217±24***	236±29^†††
PCO2, mmHg	38±3	40±3	40±2
HCO3^−, mmol/L	17.3±1.7	19.1±1.2*	20.6±1.7^†††,‡
BE, mmol/L	−10.3±1.3	−7.7±2.8*	−4.7±3.1^†††,‡
Lactate, mmol/L	10.2±1.5	7.6±2.7*	6.5±2.4^††
HR, beat/min	292±2	335±16***	334±15^†††
MAP, mmHg	61±2	85±6***	87±6^†††
RPP, mmHg*beat/min	24520±974	39191±3032***	39108±2207^†††
After 72 Hours
pH	7.28±0.08	7.38±0.03*	7.37±0.03^†
PO2, mmHg	91±12	116±15***	113±10^††
PCO2, mmHg	37±2	38±3	39±3
HCO3^−, mmol/L	19.9±1.7	23.0±2.3**	22.9±1.5^††
BE, mmol/L	−5.1±2.1	−3.3±1.4*	−2.8±1.3^††
Lactate, mmol/L	5.5±2.1	3.2±1.6*	3.4±1.7^†
HR, beat/min	307±12	340±13***	337±12^†††
MAP, mmHg	71±7	85±5***	83±7^†††
RPP, mmHg*beat/min	28617±2546	41918±2992***	41506±2501^†††

Notes: The Control, LCT and LCT/MCT groups displayed differences in pH at 120 minutes (P=0.001); Control group vs LCT group, P=0.109; Control group vs LCT/MCT group, P=0.001; LCT group vs LCT/MCT group, P=0.063. The Control, LCT and LCT/MCT groups displayed differences in PO2 at 120 minutes (P<0.001); Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.142. The Control, LCT and LCT/MCT groups displayed differences in HCO3⁻ at 120 minutes (P<0.001); Control group vs LCT group, P=0.027; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.020. The Control, LCT and LCT/MCT groups displayed differences in BE at 120 minutes (P<0.001); Control group vs LCT group, P=0.016; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.018. The Control, LCT and LCT/MCT groups displayed differences in lactate at 120 minutes (P=0.003); Control group vs LCT group, P=0.043; Control group vs LCT/MCT group, P=0.002; LCT group vs LCT/MCT group, P=0.581. The Control, LCT and LCT/MCT groups displayed differences in HR at 120 minutes (P<0.001); Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.999. The Control, LCT and LCT/MCT groups displayed differences in MAP at 120 minutes (P<0.001); Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=0.924. The Control, LCT and LCT/MCT groups displayed differences in RPP at 120 minutes (P<0.001); Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=1.000. The Control, LCT and LCT/MCT groups displayed differences in pH after 72 hours (P<0.001); Control group vs LCT group, P=0.017; Control group vs LCT/MCT group, P=0.032; LCT group vs LCT/MCT group, P=0.609. The Control, LCT and LCT/MCT groups displayed differences in PO2 after 72 hours (P<0.001); Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P=0.001; LCT group vs LCT/MCT group, P=1.000. The Control, LCT and LCT/MCT groups displayed differences in HCO3⁻ after 72 hours (P=0.001); Control group vs LCT group, P=0.002; Control group vs LCT/MCT group, P<0.003; LCT group vs LCT/MCT group, P=1.000. The Control, LCT and LCT/MCT groups displayed differences in BE after 72 hours (P=0.005); Control group vs LCT group, P=0.029; Control group vs LCT/MCT group, P=0.005; LCT group vs LCT/MCT group, P=1.000. The Control, LCT and LCT/MCT groups displayed differences in lactate after 72 hours (P=0.009); Control group vs LCT group, P=0.011; Control group vs LCT/MCT group, P=0.021; LCT group vs LCT/MCT group, P=1.000. The Control, LCT and LCT/MCT groups displayed differences in HR after 72 hours (P<0.001); Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=1.000. The Control, LCT and LCT/MCT groups displayed differences in MAP after 72 hours (P<0.001); Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=1.000. The Control, LCT and LCT/MCT groups displayed differences in RPP after 72 hours (P<0.001); Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001; LCT group vs LCT/MCT group, P=1.000. No significant differences were demonstrated among the three groups in PCO2 at 120 minutes or 72 hours after onset of resuscitation. All values are mean ± SD. *Control group vs LCT group, ^†Control group vs LCT/MCT group, ^‡LCT group vs LCT/MCT group. *P<0.05, †P<0.05, ^‡P<0.05, **P<0.01, ^††P<0.01, ***P<0.001, ^†††P<0.001.

Abbreviations: PO₂, partial pressure of oxygen; PCO₂, partial pressure of carbon dioxide; HCO₃⁻, bicarbonate radical; BE, base excess; HR, heart rate; MAP, mean arterial pressure; RPP, heart rate pressure product.

Figure 3 Neurological assessment score for rats that survived to 120 minutes in experiment A.

Notes: Significant differences were demonstrated among the three groups (P<0.001). The LCT and LCT/MCT groups had lower neurological assessment score compared with the Control group (Control group vs LCT group, P=0.001; Control group vs LCT/MCT group, P<0.001), and LCT/MCT groups had lower neurological assessment score compared with the LCT group (LCT group vs LCT/MCT group, P<0.001). **P<0.01, ***P<0.001.

Figure 4 (A) Lung permeability index for rats that survived to 120 minutes in experiment A.

Notes: Significant differences were demonstrated among the three groups (P<0.001). The LCT and LCT/MCT groups had lower lung permeability index compared with the Control group (Control group vs LCT group, P<0.001; Control group vs LCT/MCT group, P<0.001). (B) Wet-to-dry ratio for rats that survived to 120 minutes in experiment A. Significant differences were demonstrated among the three groups (P=0.003). The LCT and LCT/MCT groups had lower wet-to-dry ratio compared with the Control group (Control group vs LCT group, P=0.002; Control group vs LCT/MCT group, P=0.033). *P<0.05, **P<0.01, ***P<0.001.

Figure 5 Energy charge at 0, 20, 40, 60, 80, 100 and 120 minutes.

Notes: Significant differences were demonstrated among the three groups at 20 (P<0.001), 40 (P<0.001) and 60 minutes (P<0.001). The LCT/MCT group had higher energy charge compared with the Control group at 20 (P<0.001) and 40 minutes (P<0.001). The LCT group had higher energy charge compared with the Control group at 40 (P<0.001) and 60 minutes (P<0.001). The LCT/MCT group had higher energy charge at 20 (P<0.001) and 40 minutes (P<0.001), and lower energy charge at 60 minutes (<0.001) compared with the LCT group. No significant difference was demonstrated among the three groups in energy charge at 0, 80, 100 or 120 minutes ***P<0.001.