Milrinone combined with vasopressin improves cardiac index after cardiopulmonary resuscitation in a pig model of myocardial infarction.
BACKGROUND
Milrinone used for acute cardiac insufficiency could be of interest during cardiopulmonary resuscitation because of its positive inotropic effects. In this study, the combination of milrinone-vasopressin was compared with epinephrine and vasopressin, as well as with the combination of epinephrine-vasopressin, in reference to hemodynamics.


METHODS
Thirty-two pigs underwent ligation of the circumflex coronary artery and induction of ventricular fibrillation lasting for 4 min. Cardiopulmonary resuscitation was performed after randomization to one of four groups: epinephrine (30-microg/kg bolus), vasopressin (0.4-U/kg bolus), epinephrine-vasopressin (15-microg/kg epinephrine bolus, 0.2-U/kg vasopressin bolus), or milrinone-vasopressin (0.4-U/kg vasopressin bolus, 50-microg/kg milrinone bolus over 5 min and a continuous infusion of 0.4 microg.kg.min). The hemodynamic variables were measured before cardiopulmonary resuscitation as well as 4, 8, 15, and 30 min after return of spontaneous circulation.


RESULTS
All animals were resuscitated successfully. The animals of the milrinone-vasopressin group displayed significantly (P<0.05) higher cardiac index values (30 min after return of spontaneous circulation: epinephrine, 65.8+/-13.2; vasopressin, 70.7+/-18.3; epinephrine-vasopressin, 69.1+/-36.2; milrinone-vasopressin, 120.7+/-34.8 ml.min.kg) without a decrease in mean arterial pressure or coronary perfusion pressure.


CONCLUSIONS
The combination of vasopressin-milrinone as compared with epinephrine during cardiopulmonary resuscitation leads to an improved cardiac index without relevant decrease of mean arterial pressure or coronary perfusion pressure.
Palmaers
Thomas
T
Department of Anesthesiology, University Hospital Erlangen, Germany. palmaers@kfa.imed.uni-erlangen.de
Albrecht
Sven
S
Heuser
Fabian
F
Leuthold
Christian
C
Schuettler
Juergen
J
Schmitz
Bernd
B
D000818:Animals; D001794:Blood Pressure / Q000187:drug effects*; D016887:Cardiopulmonary Resuscitation; D003326:Coronary Circulation / Q000187:drug effects*; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D008297:Male; D020105:Milrinone / Q000008:administration & dosage*; D009203:Myocardial Infarction / Q000628:therapy*; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage*; D013552:Swine; D014667:Vasopressins / Q000008:administration & dosage*
D010726:Phosphodiesterase Inhibitors; D014667:Vasopressins; D020105:Milrinone