Combined use of dopamine and nitroprusside therapy in conjunction with intra-aortic balloon pumping for the treatment of postcardiotomy low-output syndrome

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 82; no. 1; p. 13
• Main Authors: Sturm, J T, Fuhrman, T M, Sterling, R, Turner, S A, Igo, S R, Norman, J C
• Format: Journal Article
• Language: English
• Published: United States 01-07-1981
• Subjects: Assisted Circulation; Cardiac Output, Low - therapy; Dopamine - therapeutic use; Drug Therapy, Combination; Ferricyanides - therapeutic use; Hemodynamics - drug effects; Humans; Intra-Aortic Balloon Pumping; Nitroprusside - therapeutic use; Vascular Resistance - drug effects
• ISSN: 0022-5223
• DOI: 10.1016/s0022-5223(19)39381-x

Intra-aortic balloon pumping (IABP) has been utilized in our institution in over 600 patients for the treatment of postcardiotomy low-output syndrome, with a 59% survival rate. Volume loading and pharmacologic treatment have played integral roles in the overall treatment of this syndrome. This investigation documents the hemodynamic effectivenss of combined nitroprusside/dopamine therapy in patients who required IABP for weaning from cardiopulmonary bypass. Serial hemodynamic measurements were made before and during infusion of nitroprusside (0.5 to 5.0 microgram/kg/min) and after combined nitroprusside/dopamine (7.5 micrograms/kg/min) therapy in 10 patients during IABP. Prior to pharmacologic therapy, cardiac index was 1.6 +/- 0.4 L/min/m2 and systemic vascular resistance (SVR) was 2,774 +/- 932 dynes sec cm-5. After nitroprusside infusion, cardiac index increased to 1.8 +/- 0.5 L/min/m2 (NS) and SVR decreased to 1,957 +/- 791 dynes sec cm-5 (p less than 0.01). The simultaneous infusion of nitroprusside and dopamine resulted in further augmentation of cardiac index to 2.5 +/- 0.5 L/min/m2 (p less than 0.01) and an additional reduction of SVR to 1,439 +/- 358 dynes sec cm-5 (p less than 0.02). In addition, pressure-rate-product, an index of myocardial oxygen demand, was decreased by nitroprusside (p less than 0.02) but was not significantly altered by both agents. This study provides a rationale for the combined use of nitroprusside/dopamine in postcardiotomy low-output syndrome necessitating IABP when SVR is greater than 2,000 dynes sec cm-5 and cardiac index is less than 2.0 L/min/m2.