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  • Open Access

Levosimendan does not improve resuscitation success after hypovolemic cardiac arrest

  • 1 and
  • 1
Critical Care200812 (Suppl 2) :P265

https://doi.org/10.1186/cc6486

  • Published:

Keywords

  • Vasopressin
  • Dobutamine
  • Ventricular Fibrillation
  • Cardiopulmonary Resuscitation
  • Levosimendan

Introduction

Resuscitation from hemorrhagic shock and subsequent cardiac arrest (CA) is a major clinical challenge in the care of trauma patients. Levosimendan, a new calcium sensitizer, exerts positive inotropic and lusitropic effects in failing human myocardium without increase in energy expenditure [1]. The aim of this study was to evaluate possible beneficial effects of levosimendan in combination with vasopressin in hypovolemic CA and subsequent cardiopulmonary resuscitation.

Methods

Five anesthetized male piglets (26.5 ± 1.1 kg) were bled (25.1 ± 3.4% of calculated total blood volume) to a mean arterial blood pressure of 35 mmHg during 12.9 ± 0.2 minutes. Afterwards the piglets were subject to 4 minutes untreated ventricular fibrillation followed by 12 minutes open-chest cardiopulmonary resuscitation (CPR). At 5 minutes of CA, 0.4 U/kg vasopressin and 12 μg/kg levosimendan were given intravenously and an infusion of 3 ml/kg hypertonic saline and dextran (7.5% saline, 6% dextran 70) was given in 20 minutes. Internal defibrillation was attempted from 7 minutes of CA to achieve restoration of spontaneous circulation (ROSC). If necessary, at 8 minutes of CA, 0.4 U/kg vasopressin was repeated intravenously. Hemodynamic variables, continuous cerebral cortical blood flow and blood gas parameters were measured during CPR and up to 180 minutes after ROSC. Blood samples for 8-iso-PGF, 15-keto-dihydro-PGF, protein S-100β and troponin I were taken.

Results

ROSC was achieved in two out of five piglets. Only one of these piglets survived the whole experiment. Another piglet died 60 minutes after ROSC due to a new episode of ventricular fibrillation. It was difficult to achieve ROSC due to persistent ventricular fibrillation during CPR. The mean number of defibrillation attempts was 14.2 (range: 8–21). The mean coronary perfusion pressure was 19–21 mmHg during CPR. Piglets that achieved ROSC needed a constant dobutamine infusion for hemodynamic stability. Concentrations of troponin I continuously increased after ROSC, reaching maximum levels at the end of the study. During the very early reperfusion phase (5–15 min after ROSC) the cerebral cortical blood flow was 18–47% greater than baseline values. Thereafter, it remained elevated about 18% at 30 minutes, and was decreased to baseline level during the remainder of the experiment.

Conclusion

A combination of levosimendan and vasopressin did not improve resuscitation success. A combination of levosimendan and vasopressin produced ventricular fibrillation resistant to defibrillation attempts in a hypovolemic cardiac arrest model. Further studies are necessary in order to evaluate effects of vasopressin and other inotropic agents in hypovolemic animal models.

Authors’ Affiliations

(1)
Uppsala University Hospital, Uppsala, Sweden

References

  1. De Luca L, et al.: Eur Heart J. 2006, 27: 1908-1920. 10.1093/eurheartj/ehi875PubMedView ArticleGoogle Scholar

Copyright

© BioMed Central Ltd 2008

This article is published under license to BioMed Central Ltd.

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