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/kgmin 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/kgmin) 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 6h for the 5 and 7.5 mcg/kgmin groups. Tachycardia manifested with all dobutamine doses, but only affected myocardial oxygen consumption significantly (P < 0.05) at the highest dose (7.5 mcg/kgmin).

CONCLUSIONS:

Dobutamine at 5 mcg/kgmin appears optimal for restoring systolic and diastolic function post-resuscitation without adversely affecting myocardial oxygen consumption.

• Authors: Alejandro Vasquez, Karl B Kern, Ronald W Hilwig, Joseph Heidenreich, Robert A Berg, Gordon A Ewy
• Journal: Resuscitation (Resuscitation) Vol. 61 Issue 2 Pg. 199-207 (May 2004) ISSN: 0300-9572 [Print] Ireland
• PMID: 15135197 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Dobutamine

Topics

• Analysis of Variance
• Animals
• Cardiopulmonary Resuscitation (adverse effects, methods)
• Disease Models, Animal
• Dobutamine (pharmacology)
• Dose-Response Relationship, Drug
• Female
• Hemodynamics (drug effects, physiology)
• Male
• Probability
• Random Allocation
• Risk Factors
• Sensitivity and Specificity
• Survival Rate
• Sus scrofa
• Ventricular Dysfunction, Left (drug therapy, etiology)
• Ventricular Fibrillation (therapy)