Treatment of post resuscitation myocardial dysfunction: aortic counterpulsation versus dobutamine.
BACKGROUND
Post resuscitation myocardial stunning is well described and recognized as a significant contributor to poor long-term outcome following cardiac arrest. Optimal strategies for treatment have not been determined.


METHODS
Ten domestic swine (49+/-3 kg) underwent 15 min of untreated ventricular fibrillation before being successfully resuscitated. Left ventricular systolic and diastolic function was measured at pre-arrest baseline, at 30 min and at 6 h post resuscitation. Five animals were treated immediately after resuscitation with intra-aortic balloon counterpulsation (IABP) and five were given dobutamine (5 mcg/kg per min).


RESULTS
No baseline differences were found. At 30 min post resuscitation pulmonary capillary wedge pressure and LVEDP were significantly higher (16+/-3 vs. 7+/-1 and 20+/-2 vs. 11+/-1 mmHg) while LV isovolumic relaxation ('Tau') was significantly longer (34+/-2 vs. 20+/-2 ms) in the IABP treated versus the dobutamine treated animals. Likewise, at 6 h post resuscitation LV ejection fraction was significantly less (21+/-6 vs. 39+/-4%), and LVEDP significantly higher (18 vs. 10 mmHg) in the IABP group. Heart rate was not different between the groups at any time post resuscitation.


CONCLUSIONS
Dobutamine was superior to IABP for treatment of post resuscitation left ventricular systolic and diastolic dysfunction. The hypothesized advantage of IABP for treatment of post resuscitation myocardial stunning without excessively raising the heart rate like dobutamine was not realized.
Tennyson
Heath
H
Department of Medicine, Section of Cardiology, The Sarver Heart Center, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 95724, USA.
Kern
Karl B
KB
Hilwig
Ronald W
RW
Berg
Robert A
RA
Ewy
Gordon A
GA
D000818:Animals; D009202:Cardiomyopathies / Q000209:etiology / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D015908:Counterpulsation; D004195:Disease Models, Animal; D004280:Dobutamine / Q000627:therapeutic use*; D006323:Heart Arrest / Q000628:therapy*; D007423:Intra-Aortic Balloon Pumping; D013552:Swine
D002316:Cardiotonic Agents; D004280:Dobutamine