Synergistic Effects of Moderate Therapeutic Hypothermia and Levosimendan on Cardiac Function and Survival After Asphyxia-Induced Cardiac Arrest in Rats
Journal
Journal of the American Heart Association
Journal Volume
9
Journal Issue
12
Pages
e016139
Date Issued
2020
Abstract
BACKGROUND: This study investigated whether levosimendan, an inotropic calcium sensitizer, when combined with moderate therapeutic hypothermia, may exert synergistic benefits on post-cardiac arrest myocardial dysfunction and improve outcomes. METHODS AND RESULTS: After 9.5-minute asphyxia-induced cardiac arrest and resuscitation, 48 rats were randomized equally into 4 groups following return of spontaneous circulation (ROSC), including normothermia, hypothermia, normothermia-levosimendan, and hypothermia-levosimendan groups. For the normothermia group, the target temperature was 37°C while for the hypothermia group, the target temperature was 32°C, both of which were to be maintained for 4 hours after ROSC. Levosimendan was administered after ROSC with a loading dose of 10 ?g/kg and then infused at 0.1 ?g/kg per min for 4 hours. In the hypothermia-levosimendan group, left ventricular systolic function and cardiac output increased significantly, whereas the heart rate and systemic vascular resistance decreased significantly compared with the normothermia group. Also, the concentrations of interleukin 1β at 4 hours post-ROSC and the production of NO between 1 hour and 4 hours post-ROSC were reduced significantly in the hypothermia-levosimendan group compared with the normothermia group. The 72-hour post-ROSC survival and neurological recovery were also significantly better in the hypothermia-levosimendan group compared with the normothermia group (survival, 100% versus 50%,?2 test, P=0.006). CONCLUSIONS: Compared with normothermia, only combined moderate therapeutic hypothermia and levosimendan treatment could consistently improve post-cardiac arrest myocardial dysfunction and decrease the release of pro-inflammatory molecules, thereby improving survival and neurological outcomes. These findings suggest synergistic benefits between moderate therapeutic hypothermia and levosimendan. ? 2020 The Authors.
SDGs
Other Subjects
interleukin 1beta; levosimendan; biological marker; cardiotonic agent; IL1B protein, rat; Il6 protein, rat; interleukin 1beta; interleukin 6; nitric acid derivative; nitrite; simendan; animal experiment; animal model; Article; asphyxia; body temperature; bradycardia; brain damage; brain injury; brain tissue; controlled study; diastolic blood pressure; endotracheal intubation; extubation; heart arrest; heart function; heart output; heart rate; hippocampal CA1 region; hippocampal CA2 region; hippocampal CA3 region; hippocampus; histopathology; hospital discharge; hypotension; hypothermia; immune response; inflammation; left hemisphere; loading drug dose; macrophage; male; mean arterial pressure; mortality rate; nonhuman; phagocytosis; priority journal; randomized controlled trial; rat; resuscitation; return of spontaneous circulation; synergistic effect; systemic vascular resistance; systolic blood pressure; animal; asphyxia; blood; comparative study; complication; convalescence; disease model; drug effect; heart arrest; heart left ventricle function; induced hypothermia; multimodality cancer therapy; pathophysiology; time factor; Wistar rat; Animals; Asphyxia; Biomarkers; Cardiac Output; Cardiotonic Agents; Combined Modality Therapy; Disease Models, Animal; Heart Arrest; Hypothermia, Induced; Interleukin-1beta; Interleukin-6; Male; Nitrates; Nitrites; Rats, Wistar; Recovery of Function; Return of Spontaneous Circulation; Simendan; Time Factors; Ventricular Function, Left
Type
journal article