title: Levosimendan Improves Neurological Outcome in a Swine Model of Asphyxial Cardiac Arrest.
abstract: BACKGROUND
  In asphyxial cardiac arrest, the severe hypoxic stress complicates the resuscitation efforts and results in poor neurological outcomes. Our aim was to assess the effects of levosimendan on a swine model of asphyxial cardiac arrest.
  
  
  METHODS
  Asphyxial cardiac arrest was induced in 20 Landrace/Large White piglets, which were subsequently left untreated for four minutes. The animals were randomised to receive adrenaline alone (n=10, Group A) and adrenaline plus levosimendan (n=10, Group B). All animals were resuscitated according to the 2010 European Resuscitation Council guidelines. Haemodynamic variables were measured before arrest, during arrest and resuscitation, and during the first 30 minutes after return of spontaneous circulation (ROSC), while survival and neurologic alertness score were measured 24 hours later.
  
  
  RESULTS
  Return of spontaneous circulation was achieved in six animals (60%) from Group A and nine animals (90%) from Group B (p=0.303). During the first minute of cardiopulmonary resuscitation, coronary perfusion pressure was significantly higher in Group B (p=0.046), but there was no significant difference at subsequent time points until ROSC. Although six animals (60%) from each group survived after 24 hours (p=1.000), neurologic examination was significantly better in the animals of Group B (p<0.01).
  
  
  CONCLUSIONS
  The addition of levosimendan to adrenaline improved coronary perfusion pressure immediately after the onset of cardiopulmonary resuscitation and resulted in better 24-hour neurological outcome.
authors.affiliation: National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
authors.forename: Maria Louiza
authors.initials: ML
authors.lastname: Kosmidou
authors.affiliation: National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xanthos
authors.affiliation: National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece. Electronic address: thanoschalkias@yahoo.gr.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Chalkias
authors.affiliation: National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Lelovas
authors.affiliation: National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
authors.forename: Giolanda
authors.initials: G
authors.lastname: Varvarousi
authors.affiliation: National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
authors.forename: Nektaria
authors.initials: N
authors.lastname: Lekka
authors.affiliation: National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Lappas
authors.affiliation: National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
authors.forename: Lila
authors.initials: L
authors.lastname: Papadimitriou
authors.affiliation: National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
authors.forename: Despoina
authors.initials: D
authors.lastname: Perrea
authors.affiliation: National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
authors.forename: Ismene
authors.initials: I
authors.lastname: Dontas
mesh_terms: D000818:Animals; D001237:Asphyxia / Q000188:drug therapy / Q000503:physiopathology; D004195:Disease Models, Animal; D006323:Heart Arrest / Q000188:drug therapy / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects*; D006835:Hydrazones / Q000008:administration & dosage*; D011724:Pyridazines / Q000008:administration & dosage*; D000077464:Simendan; D013552:Swine
chemical_list: D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan
keywords: Asphyxia; Cardiac arrest; Cardiopulmonary resuscitation; Levosimendan; Neurological outcome