Multicenter Placebo-Controlled Randomized Study of Ethyl Pyruvate in Horses Following Surgical Treatment for ≥ 360° Large Colon Volvulus.
Authors: Johnson Lindsey M, Holcombe Susan J, Shearer Tara R, Watson Victoria, Gandy Jeffery, Southwood Louise L, Lynch Tymothy M, Schroeder Eric L, Fogle Callie A, Sordillo Lorraine M
Journal: Frontiers in veterinary science
Summary
Large colon volvulus remains one of equine surgery's most challenging emergencies, with post-operative mortality driven partly by ischaemic tissue damage and delayed mucosal healing; this multicentre randomised controlled trial investigated whether ethyl pyruvate—an agent that has shown promise in reducing ischaemic injury in rodent, ovine and porcine models—could improve outcomes in 22 horses (12 treatment, 10 control) receiving either 150 mg/kg ethyl pyruvate or placebo every 6 hours for 24 hours post-operatively. Survival to hospital discharge was comparable between groups (58% ethyl pyruvate versus 50% control), with no significant differences in post-operative heart rate, packed cell volume, total solids, blood lactate, inflammatory gene expression or faecal consistency, and no adverse events were documented with ethyl pyruvate administration. Notably, elevated heart rate, packed cell volume and blood lactate concentration at admission and 24 hours post-operatively emerged as independent predictors of mortality, with tachycardia persisting at 48 hours also associated with fatal outcomes—findings which reinforce the prognostic value of these readily available parameters in the immediate post-operative window. Whilst ethyl pyruvate appears safe to administer, the underpowered sample size limits definitive conclusions about efficacy, though the study highlights that multi-modal approaches targeting ischaemia-reperfusion injury in severe LCV may require different dosing strategies or combination therapies rather than standalone pharmacological intervention. For practitioners, post-operative monitoring of heart rate and blood work abnormalities remains the most reliable tool for risk stratification in these high-mortality cases.
Read the full abstract on PubMed
Practical Takeaways
- •Ethyl pyruvate cannot currently be recommended as an adjunctive therapy to improve survival in horses recovering from large colon volvulus surgery based on available evidence.
- •Post-operative heart rate, PCV, and L-lactate concentration are more useful prognostic indicators for survival than ethyl pyruvate administration and should be monitored closely.
- •While ethyl pyruvate showed safety in this trial, larger prospective studies are needed before considering its clinical adoption for LCV cases.
Key Findings
- •Ethyl pyruvate was safely administered at 150 mg/kg IV every 6 hours for 24 hours post-operatively with no adverse events reported.
- •No significant difference in survival between ethyl pyruvate-treated horses (58.3%, 7/12) and controls (50%, 5/10) following LCV surgical correction.
- •Higher heart rate, packed cell volume, and blood L-lactate concentration at admission and 24 hours post-surgery were significantly associated with mortality (p=0.005, 0.01, 0.04 respectively).
- •Study was underpowered with only 22 horses enrolled, limiting ability to detect treatment effects and indicating need for larger multicenter trial.