Supplement of levosimendan to epinephrine improves initial resuscitation outcomes from asphyxial cardiac arrest

BMC Anesthesiol. 2017 Feb 2;17(1):18. doi: 10.1186/s12871-017-0309-3.

Abstract

Background: Levosimendan exerted favorable effects on the initial outcome in the treatment of ventricular fibrillation cardiac arrest. This study investigated the efficacy of levosimendan in the treatment of asphyxia-induced cardiac arrest in rats.

Methods: Animals underwent asphyxial cardiac arrest/cardiopulmonary resuscitation, randomized to three treatment groups: epinephrine (10 μg/kg) supplemented with levosimendan (bolus 12 μg/kg and infusion for 1 h, EL group); epinephrine only (10 μg/kg, E group), or levosimendan only (bolus 12 μg/kg and infusion for 1 h, L group). The resuscitation success rate, wet-to-dry ratio of lung, and rate of alveolar and blood gas analysis were recorded.

Results: 10 rats in the EL group, 8 in the E group, and 2 in the L group showed an initial return of spontaneous circulation (P < 0.001); among them, 10, 4, and 2 rats survived at the end of a 60-min observation period from each group, respectively (P = 0.001). The coronary perfusion pressure in the EL group was higher than that of either the E or L group (P < 0.05). The lung wet-to-dry weight ratio and rate of damaged alveoli were lower in the EL group than the E group (P < 0.05).

Conclusions: In the early stage of resuscitation for asphyxia-induced cardiac arrest in rats, levosimendan supplemented with epinephrine can significantly increase coronary perfusion pressure, reduce lung injury, and ultimately enhance the survival rate.

Keywords: Asphyxia; CPR; Cardiac arrest; Epinephrine; Levosimendan.

MeSH terms

  • Acute Lung Injury / pathology
  • Acute Lung Injury / prevention & control
  • Animals
  • Anti-Arrhythmia Agents / administration & dosage*
  • Asphyxia / etiology
  • Asphyxia / therapy
  • Bronchodilator Agents / administration & dosage*
  • Coronary Circulation / drug effects
  • Drug Therapy, Combination
  • Epinephrine / administration & dosage*
  • Heart Arrest, Induced
  • Hydrazones / administration & dosage*
  • Lung / pathology
  • Pyridazines / administration & dosage*
  • Rats, Sprague-Dawley
  • Resuscitation / methods*
  • Simendan

Substances

  • Anti-Arrhythmia Agents
  • Bronchodilator Agents
  • Hydrazones
  • Pyridazines
  • Simendan
  • Epinephrine