Optimal dosing of dobutamine for treating post-resuscitation left ventricular dysfunction

Alejandro Vasquez, Karl B Kern, Ronald W. Hilwig, Joseph Heidenreich, Robert A. Berg, Gordon A. Ewy

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Objectives: This study was designed to determine the optimal dose of dobutamine in the treatment of post-resuscitation left ventricular dysfunction. Background: Global left ventricular dysfunction following successful resuscitation from prolonged, ventricular fibrillation cardiac arrest, negatively impacts long-term survival. Dobutamine can overcome this global myocardial stunning. Previous data indicate a dose of 10 mcg/kg min improves systolic and diastolic function, but markedly increases the heart rate. Methods: Twenty swine (24±0.4 kg) were randomized to one of four doses (0, 2, 5, and 7.5 mcg/kg min) of dobutamine for the treatment of post-resuscitation myocardial dysfunction following 12.5 min of untreated ventricular fibrillation cardiac arrest. Cardiac function was measured at pre-arrest baseline and serially for 6 h post-resuscitation. Left ventricular function was evaluated by contrast ventriculograms, left ventricular pressures, +dP/dt, Tau, -dP/dt, and cardiac output. Myocardial oxygen consumption and myocardial blood flow were measured to assess the functional significance of any dobutamine-mediated heart rate responses. Results: Left ventricular dysfunction was evident at 25 min and peaked 4 h post-resuscitation. Significant (P<0.05) improvements in ventricular systolic (EF, CO) and diastolic (LVEDP, Tau) function were evident within minutes of dobutamine initiation and persisted at 6 h for the 5 and 7.5 mcg/kg min groups. Tachycardia manifested with all dobutamine doses, but only affected myocardial oxygen consumption significantly (P<0.05) at the highest dose (7.5 mcg/kg min). Conclusions: Dobutamine at 5 mcg/kg min appears optimal for restoring systolic and diastolic function post-resuscitation without adversely affecting myocardial oxygen consumption.

Original languageEnglish (US)
Pages (from-to)199-207
Number of pages9
JournalResuscitation
Volume61
Issue number2
DOIs
StatePublished - May 2004

Fingerprint

Dobutamine
Left Ventricular Dysfunction
Resuscitation
Oxygen Consumption
Ventricular Fibrillation
Heart Arrest
Heart Rate
Myocardial Stunning
Ventricular Pressure
Carbon Monoxide
Left Ventricular Function
Tachycardia
Cardiac Output
Swine
Therapeutics

Keywords

  • AoP
  • aortic pressure
  • cardiac output
  • cardiopulmonary resuscitation
  • CO
  • CPR
  • J/kg
  • joules per kilogram
  • left ventricular end diastolic pressure
  • left ventricular pressure
  • left ventricular stroke work
  • LVEDP
  • LVP
  • LVSW
  • PA
  • PAOP
  • pulmonary artery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

Cite this

Optimal dosing of dobutamine for treating post-resuscitation left ventricular dysfunction. / Vasquez, Alejandro; Kern, Karl B; Hilwig, Ronald W.; Heidenreich, Joseph; Berg, Robert A.; Ewy, Gordon A.

In: Resuscitation, Vol. 61, No. 2, 05.2004, p. 199-207.

Research output: Contribution to journalArticle

Vasquez, Alejandro ; Kern, Karl B ; Hilwig, Ronald W. ; Heidenreich, Joseph ; Berg, Robert A. ; Ewy, Gordon A. / Optimal dosing of dobutamine for treating post-resuscitation left ventricular dysfunction. In: Resuscitation. 2004 ; Vol. 61, No. 2. pp. 199-207.
@article{d1aee18d72aa4d8d988b1e6817e1355c,
title = "Optimal dosing of dobutamine for treating post-resuscitation left ventricular dysfunction",
abstract = "Objectives: This study was designed to determine the optimal dose of dobutamine in the treatment of post-resuscitation left ventricular dysfunction. Background: Global left ventricular dysfunction following successful resuscitation from prolonged, ventricular fibrillation cardiac arrest, negatively impacts long-term survival. Dobutamine can overcome this global myocardial stunning. Previous data indicate a dose of 10 mcg/kg min improves systolic and diastolic function, but markedly increases the heart rate. Methods: Twenty swine (24±0.4 kg) were randomized to one of four doses (0, 2, 5, and 7.5 mcg/kg min) of dobutamine for the treatment of post-resuscitation myocardial dysfunction following 12.5 min of untreated ventricular fibrillation cardiac arrest. Cardiac function was measured at pre-arrest baseline and serially for 6 h post-resuscitation. Left ventricular function was evaluated by contrast ventriculograms, left ventricular pressures, +dP/dt, Tau, -dP/dt, and cardiac output. Myocardial oxygen consumption and myocardial blood flow were measured to assess the functional significance of any dobutamine-mediated heart rate responses. Results: Left ventricular dysfunction was evident at 25 min and peaked 4 h post-resuscitation. Significant (P<0.05) improvements in ventricular systolic (EF, CO) and diastolic (LVEDP, Tau) function were evident within minutes of dobutamine initiation and persisted at 6 h for the 5 and 7.5 mcg/kg min groups. Tachycardia manifested with all dobutamine doses, but only affected myocardial oxygen consumption significantly (P<0.05) at the highest dose (7.5 mcg/kg min). Conclusions: Dobutamine at 5 mcg/kg min appears optimal for restoring systolic and diastolic function post-resuscitation without adversely affecting myocardial oxygen consumption.",
keywords = "AoP, aortic pressure, cardiac output, cardiopulmonary resuscitation, CO, CPR, J/kg, joules per kilogram, left ventricular end diastolic pressure, left ventricular pressure, left ventricular stroke work, LVEDP, LVP, LVSW, PA, PAOP, pulmonary artery",
author = "Alejandro Vasquez and Kern, {Karl B} and Hilwig, {Ronald W.} and Joseph Heidenreich and Berg, {Robert A.} and Ewy, {Gordon A.}",
year = "2004",
month = "5",
doi = "10.1016/j.resuscitation.2004.01.002",
language = "English (US)",
volume = "61",
pages = "199--207",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",
number = "2",

}

TY - JOUR

T1 - Optimal dosing of dobutamine for treating post-resuscitation left ventricular dysfunction

AU - Vasquez, Alejandro

AU - Kern, Karl B

AU - Hilwig, Ronald W.

AU - Heidenreich, Joseph

AU - Berg, Robert A.

AU - Ewy, Gordon A.

PY - 2004/5

Y1 - 2004/5

N2 - Objectives: This study was designed to determine the optimal dose of dobutamine in the treatment of post-resuscitation left ventricular dysfunction. Background: Global left ventricular dysfunction following successful resuscitation from prolonged, ventricular fibrillation cardiac arrest, negatively impacts long-term survival. Dobutamine can overcome this global myocardial stunning. Previous data indicate a dose of 10 mcg/kg min improves systolic and diastolic function, but markedly increases the heart rate. Methods: Twenty swine (24±0.4 kg) were randomized to one of four doses (0, 2, 5, and 7.5 mcg/kg min) of dobutamine for the treatment of post-resuscitation myocardial dysfunction following 12.5 min of untreated ventricular fibrillation cardiac arrest. Cardiac function was measured at pre-arrest baseline and serially for 6 h post-resuscitation. Left ventricular function was evaluated by contrast ventriculograms, left ventricular pressures, +dP/dt, Tau, -dP/dt, and cardiac output. Myocardial oxygen consumption and myocardial blood flow were measured to assess the functional significance of any dobutamine-mediated heart rate responses. Results: Left ventricular dysfunction was evident at 25 min and peaked 4 h post-resuscitation. Significant (P<0.05) improvements in ventricular systolic (EF, CO) and diastolic (LVEDP, Tau) function were evident within minutes of dobutamine initiation and persisted at 6 h for the 5 and 7.5 mcg/kg min groups. Tachycardia manifested with all dobutamine doses, but only affected myocardial oxygen consumption significantly (P<0.05) at the highest dose (7.5 mcg/kg min). Conclusions: Dobutamine at 5 mcg/kg min appears optimal for restoring systolic and diastolic function post-resuscitation without adversely affecting myocardial oxygen consumption.

AB - Objectives: This study was designed to determine the optimal dose of dobutamine in the treatment of post-resuscitation left ventricular dysfunction. Background: Global left ventricular dysfunction following successful resuscitation from prolonged, ventricular fibrillation cardiac arrest, negatively impacts long-term survival. Dobutamine can overcome this global myocardial stunning. Previous data indicate a dose of 10 mcg/kg min improves systolic and diastolic function, but markedly increases the heart rate. Methods: Twenty swine (24±0.4 kg) were randomized to one of four doses (0, 2, 5, and 7.5 mcg/kg min) of dobutamine for the treatment of post-resuscitation myocardial dysfunction following 12.5 min of untreated ventricular fibrillation cardiac arrest. Cardiac function was measured at pre-arrest baseline and serially for 6 h post-resuscitation. Left ventricular function was evaluated by contrast ventriculograms, left ventricular pressures, +dP/dt, Tau, -dP/dt, and cardiac output. Myocardial oxygen consumption and myocardial blood flow were measured to assess the functional significance of any dobutamine-mediated heart rate responses. Results: Left ventricular dysfunction was evident at 25 min and peaked 4 h post-resuscitation. Significant (P<0.05) improvements in ventricular systolic (EF, CO) and diastolic (LVEDP, Tau) function were evident within minutes of dobutamine initiation and persisted at 6 h for the 5 and 7.5 mcg/kg min groups. Tachycardia manifested with all dobutamine doses, but only affected myocardial oxygen consumption significantly (P<0.05) at the highest dose (7.5 mcg/kg min). Conclusions: Dobutamine at 5 mcg/kg min appears optimal for restoring systolic and diastolic function post-resuscitation without adversely affecting myocardial oxygen consumption.

KW - AoP

KW - aortic pressure

KW - cardiac output

KW - cardiopulmonary resuscitation

KW - CO

KW - CPR

KW - J/kg

KW - joules per kilogram

KW - left ventricular end diastolic pressure

KW - left ventricular pressure

KW - left ventricular stroke work

KW - LVEDP

KW - LVP

KW - LVSW

KW - PA

KW - PAOP

KW - pulmonary artery

UR - http://www.scopus.com/inward/record.url?scp=2342458318&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2342458318&partnerID=8YFLogxK

U2 - 10.1016/j.resuscitation.2004.01.002

DO - 10.1016/j.resuscitation.2004.01.002

M3 - Article

C2 - 15135197

AN - SCOPUS:2342458318

VL - 61

SP - 199

EP - 207

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

IS - 2

ER -