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Milrinone and esmolol decrease cardiac damage after resuscitation from prolonged cardiac arrest
Author(s) -
ZOERNER F.,
LENNMYR F.,
WIKLUND L.,
MARTIJN C.,
SEMENAS E.
Publication year - 2015
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12480
Subject(s) - esmolol , medicine , milrinone , anesthesia , ventricular fibrillation , resuscitation , vasopressin , cardiopulmonary resuscitation , bolus (digestion) , return of spontaneous circulation , shock (circulatory) , hemodynamics , cardiac output , cardiology , heart rate , blood pressure
Background Long‐term survival after cardiac arrest ( CA ) due to shock‐refractory ventricular fibrillation ( VF ) is low. Clearly, there is a need for new pharmacological interventions in the setting of cardiopulmonary resuscitation ( CPR ) to improve outcome. Here, hemodynamic parameters and cardiac damage are compared between the treatment group (milrinone, esmolol and vasopressin) and controls (vasopressin only) during resuscitation from prolonged CA in piglets. Methods A total of 26 immature male piglets were subjected to 12‐min VF followed by 8‐min CPR . The treatment group ( n = 13) received i.v. (intravenous) boluses vasopressin 0.4 U /kg, esmolol 250 μg/kg and milrinone 25 μg/kg after 13 min, followed by i.v. boluses esmolol 375 μg/kg and milrinone 25 μg/kg after 18 min and continuous esmolol 15 μg/kg/h infusion during 180 min reperfusion, whereas controls ( n = 13) received equal amounts of vasopressin and saline. A 200 J monophasic counter‐shock was delivered to achieve resumption of spontaneous circulation ( ROSC ) after 8 min CPR . If ROSC was not achieved, another 200 J defibrillation and bolus vasopressin 0.4 U /kg would be administered in both groups. Direct current shocks at 360 J were applied as one shot per minute over maximally 5 min. Hemodynamic variables and troponin I as a marker of cardiac injury were recorded. Results Troponin I levels after 180 min reperfusion were lower in the treatment group than in controls ( P < 0.05). The treatment group received less norepinephrine ( P < 0.01) and had greater diuresis ( P < 0.01). There was no difference in survival between groups. Conclusion The combination of milrinone, esmolol and vasopressin decreased cardiac injury compared with vasopressin alone.