Milrinone Facilitates Resuscitation From Cardiac Arrest and Attenuates Postresuscitation Myocardial Dysfunction

Abstract

Background-Left ventricular (LV) dysfunction with a low cardiac index after successful CPR contributes to early death attributable to multiorgan failure, and an effective treatment has not been identified. The purpose of this study was to investigate the use of milrinone, a selective phosphodiesterase III inhibitor, as treatment for LV dysfunction after resuscitation. Methods and Results-Ventricular fibrillation (VF) was induced electrically in 32 swine. After 5 minutes of VF, CPR was initiated and animals were randomized to receive either saline (control group, nϭ16) as a bolus and infusion or milrinone 50 g/kg as a bolus and then 0.5 g/kg per min for 60 minutes (treatment group, nϭ16). After 2 minutes of CPR (total VF time, 7 minutes), countershocks were given. Coronary perfusion pressures during CPR were similar for the groups (24Ϯ2 versus 21Ϯ4 mm Hg). All animals were defibrillated; 6 of 16 control animals developed refractory postcountershock pulseless electrical activity compared with 0 of 16 treated animals (Pϭ0.018). At 30 minutes after restoration of spontaneous circulation, stroke volume (16Ϯ3 versus 26Ϯ7 mL, PϽ0.01) and LV dp/dt (793Ϯ197 versus 1108Ϯ316 mm Hg/s, PϽ0.02) were higher in the treatment group. Similar differences were observed 60 minutes after restoration of spontaneous circulation. Significant differences in heart rates between groups were not observed, and peripheral vascular resistance was significantly greater in the control group 30 and 60 minutes after resuscitation. Conclusions-Milrinone

Life‐Threatening Bradyarrhythmia After Massive Azithromycin Overdose

“…Administration of milrinone by the caregivers in the postresuscitation period was directed at improving perfusion; this drug has facilitated resuscitation and attenuated postresuscitation myocardial dysfunction. 20 We emphasize that this incident was likely the result of an error in drug administration. All drugs, of course, should be administered in the right form, to the right patient, in the right dose, by the right route, at the right time.…”

Hyperglycemia raises the threshold of levosimendan- but not milrinone-induced postconditioning in rat hearts

“…Milrinone, a phosphodiesterase 3 inhibitor (PDE-I), and levosimendan, a calcium sensitizer, are relatively new types of inotropic agent and known to facilitate functional recovery from myocardial ischemia-reperfusion injury (e.g., cardiac surgery under cardiopulmonary bypass and conditions after cardiopulmonary resuscitation), and could lead to preserved perfusion of major organs after myocardial reperfusion [7-10]. At the cardiomyocyte level, intracellular calcium overload occurs during post-ischemic reperfusion, and could cause cardiac arrhythmias or myocardial stunning.…”

The Resuscitation Outcome

“…30 Vasopressin: Endogenous vasopressin levels were found to be higher in survivors of cardiac arrest than in patients who died, suggesting that vasopressin could be beneficial in cardiac arrest. 93,94 The recovery rate was significantly higher in animals treated with vasopressin than in those treated with epinephrine.…”