Levosimendan improves the initial outcome of cardiopulmonary resuscitation in a swine model of cardiac arrest.
BACKGROUND
Cardiac arrest remains the leading cause of death in Western societies. Advanced Life Support guidelines propose epinephrine (adrenaline) for its treatment. The aim of this study was to assess whether a calcium sensitizer agent, such as levosimendan, administered in combination with epinephrine during cardiopulmonary resuscitation, would improve the initial resuscitation success.


METHODS
Ventricular fibrillation was induced in 20 Landrace/Large-White piglets, and left untreated for 8 min. Resuscitation was then attempted with precordial compressions, mechanical ventilation and electrical defibrillation. The animals were randomized into two groups (10 animals each): animals in Group A received saline as placebo (10 ml dilution, bolus) + epinephrine (0.02 mg/kg), and animals in Group B received levosimendan (0.012 mg/kg/10 ml dilution, bolus) + epinephrine (0.02 mg/kg) during cardiopulmonary resuscitation. Electrical defibrillation was attempted after 10 min of ventricular fibrillation.


RESULTS
Four animals in Group A showed restoration of spontaneous circulation and 10 in Group B (P = 0.011). The coronary perfusion pressure, saturation of peripheral oxygenation and brain regional oxygen saturation were significantly higher during cardiopulmonary resuscitation in Group B.


CONCLUSIONS
A calcium sensitizer agent, when administered during cardiopulmonary resuscitation, significantly improves initial resuscitation success and increases coronary perfusion pressure during cardiopulmonary resuscitation.
Koudouna
E
E
Department of Experimental Surgery and Surgical Research, Medical School, University of Athens, 15B Agiou Thoma Street, 11527 Athens, Greece.
Xanthos
T
T
Bassiakou
E
E
Goulas
S
S
Lelovas
P
P
Papadimitriou
D
D
Tsirikos
N
N
Papadimitriou
L
L
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy*; D006835:Hydrazones / Q000627:therapeutic use*; D008297:Male; D011724:Pyridazines / Q000627:therapeutic use*; D011897:Random Allocation; D000077464:Simendan; D013552:Swine; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000188:drug therapy*
D000316:Adrenergic alpha-Agonists; D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004837:Epinephrine