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

77 Scopus citations

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 1 2004

Keywords

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

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

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