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Acute cardiac failure in trauma patients with pre-existing coronary artery disease: New inotropic treatment option: 12AP8-7

Afonin, A. N.; Karpun, N. A.

European Journal of Anaesthesiology: June 2011 - Volume 28 - Issue - p 187–188
Abstracts and Programme: EUROANAESTHESIA 2011: The European Anaesthesiology Congress: Intensive Care Medicine
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Main Military Clinical Hospital nmd. af ter N.N. Burdenko, Department of Anaesthesiology and Intensive Care, Moscow, Russian Federation

Background and Goal of Study: Treatment of Acute Heart Failure (AHF) is particularly challenging in multitrauma victims with existing Ischemic Heart Disease (IHD). We used new calcium sensitizer inotropic drug Levosimendan to achieve improved contractility without increased afterload while decreasing rate of complications as compared to standard therapy with catecholamines alone.

Materials and Methods: We performed a prospective randomized clinical trial of 26 patients with known prior history of Coronary Artery Disease (CAD) and IHD who suffered multitrauma and subsequently developed AHF. All patients had compromised myocardial contractile function as diagnosed by invasive monitoring (Swan-Ganz Pulmonary Artery, arterial catheters) and transthoracic echocardiography. Dobutamine was administered initially to maximum dose or effect and later combined with Levosimendan (Group I, n=12) or with Adrenaline (Group II, n=14). The hemodynamic data was recorded every 6 h. for 72 h. Other parameters collected and analyzed included: ECG, Cardiac Index (CI), serum levels of lactate (SL), troponin-I (TnI), Atrial Natriuretic Peptide (ANP); duration of inotropic therapy, length of ICU stay, and incidence and type of complication.

Results and Discussion: A second inotropic drug infusion was added when AHF persisted with average CI of 2.1±0.15 l/min/M2 and Left Ventricular Ejection Fraction (LVEF) of 41±7% despite achieved normovolemia: Central Venous Pressure (CVP) 11±2 mm Hg, Pulmonary Artery Wedge Pressure (PAWP) 15±1mm Hg, and continued Dobutamine infusion to maximum effective dose. CI improved and in Gr. I was 3.5±0.14 and 2.6±0.33 l/min/M2in Gr. II (p=0,03). Duration of inotropic therapy was 71±10.5 h in Gr.I and 102±13.5 h in Gr. II (p=0,001). Gr. II patients had higher rate of arrhythmias (Lown-Wolf class 3-5), increased SL and TnI. There was no statistical significance in difference of length of ICU stay between the two groups.

Conclusion(s): We conclude that Levosimendan is an effective new addition to standard inotropic therapy in multitrauma patients with refractory AHF as evidenced by improved myocardial contractility, global perfusion, decreased inotropic therapy duration and rate of complications.

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References:

Eriksson H.I., Jalonen J.R., Heikkinen L.O. et al. Levosimendan facilitates weaning from cardiopulmonary bypass in patients undergoing coronary artery bypass grafting with impaired left ventricular function. Ann. Thorac. Surg. 2009; 87: 448-54.
    © 2011 European Society of Anaesthesiology