title: Role of levosimendan in the management of subarachnoid hemorrhage.
abstract: Aneurysmal subarachnoid hemorrhage (aSAH) is one of the leading causes of neurologic disability accounting for dismal long term survival rates. aSAH leads to a sudden increase in intracranial pressure and a massive sympathetic discharge. Excessive sympathetic stimulation leads to catecholamine mediated myocardial dysfunction and hemodynamic instability which may critically hamper brain perfusion and oxygenation. In the setting of acute aSAH, administration of vasoactive drugs aims at stabilizing impaired hemodynamics. However, studies have shown that conventional treatment with vasoactive drugs that lead to Ca(+2) overload and increase myocardial oxygen consumption, fail to restore hemodynamics and decrease cerebral blood flow. Levosimendan is a non-adrenergic inotropic Ca(+2) sensitizer with not only beneficial hemodynamic properties but also pleiotropic effects, contributing to its cardioprotective and neuroprotective role. Although there have been limited data available regarding the use of levosimendan in patients with aSAH, current evidence suggests that levosimendan may have a role in the setting of post-aSAH cardiomyopathy and decreased cerebral blood flow both in the emergency departments and in intensive care units. The purpose of this review is to provide an overview of studies of levosimendan therapy for aSAH, and describe current knowledge about the effects of levosimendan in the management of aSAH.
authors.affiliation: Intensive Care Unit, KAT Hospital, Athens, Greece. Electronic address: gvarvarousi@yahoo.gr.
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: Theodoros
authors.initials: T
authors.lastname: Xanthos
authors.affiliation: Intensive Care Unit, KAT Hospital, Athens, Greece.
authors.forename: Pavlina
authors.initials: P
authors.lastname: Sarafidou
authors.affiliation: Intensive Care Unit, KAT Hospital, Athens, Greece.
authors.forename: Ellisavet
authors.initials: E
authors.lastname: Katsioula
authors.affiliation: Intensive Care Unit, KAT Hospital, Athens, Greece.
authors.forename: Marianthi
authors.initials: M
authors.lastname: Georgiadou
authors.affiliation: Intensive Care Unit, KAT Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Eforakopoulou
authors.affiliation: Intensive Care Unit, KAT Hospital, Athens, Greece.
authors.forename: Hlias
authors.initials: H
authors.lastname: Pavlou
mesh_terms: D002316:Cardiotonic Agents / Q000627:therapeutic use*; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D017682:Myocardial Stunning / Q000188:drug therapy* / Q000209:etiology; D011724:Pyridazines / Q000627:therapeutic use*; D000077464:Simendan; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan