@article{3131181,
    title = "Combination pharmacotherapy in the treatment of experimental cardiac arrest",
    author = "Xanthos, T. and Bassiakou, E. and Koudouna, E. and Rokas, G. and Goulas, S. and Dontas, I. and Kouskouni, E. and Perrea, D. and Papadimitriou, L.",
    journal = "The American Journal of Emergency Medicine",
    year = "2009",
    volume = "27",
    number = "6",
    pages = "651-659",
    issn = "0735-6757",
    doi = "10.1016/j.ajem.2008.05.004",
    keywords = "adrenalin;  atenolol;  levosimendan;  neuron specific enolase;  placebo;  protein S 100;  troponin I, alertness;  animal experiment;  animal model;  article;  controlled study;  defibrillation;  experimental model;  experimental pig;  female;  heart arrest;  heart function;  heart output;  heart ventricle fibrillation;  male;  nonhuman;  piglet;  priority journal;  protein blood level;  resuscitation;  survival time;  therapy effect;  treatment outcome;  treatment response, Adrenergic beta-Agonists;  Animals;  Atenolol;  Cardiotonic Agents;  Disease Models, Animal;  Drug Therapy, Combination;  Epinephrine;  Heart Arrest;  Hydrazones;  Lactic Acid;  Phosphopyruvate Hydratase;  Pyridazines;  S100 Proteins;  Swine;  Troponin I",
    abstract = "Study Objectives: Full recovery after cardiopulmonary resuscitation (CPR) is poor. We hypothesized that the coadministration of epinephrine, a β-blocker such as atenolol, and a calcium sensitizer such as levosimendan during CPR would improve survival and postresuscitation myocardial function. Methods: Ventricular fibrillation was induced in 60 piglets, which were left untreated for 8 minutes before attempted resuscitation. Animals were randomized into 4 groups (n = 15), to receive epinephrine (group E), epinephrine + atenolol (group E + A), epinephrine + levosimendan (group E + L) and epinephrine + atenolol + levosimendan (group E + A + L) during CPR. Electrical defibrillation was attempted 2 minutes after drug administration. Results: Five animals in group E survived for 48 hours in comparison to 8 animals in groups E + A and E + L and 12 animals in group E + A + L. Postresuscitation cardiac output was significantly better in the animals of group E + A + L. Troponin I remained significantly lower in groups E + A and E + A + L. Serum astroglial protein (S-100) and neuron-specific enolase values in group E + L and E + A + L were statistically lower than those measured in groups E and E + A during the entire observation period. The neurologic alertness score was higher in group E + A + L compared to groups E and E + A. Conclusions: The administration of a drug combination of epinephrine + atenolol + levosimendan, when given during CPR, in a pig model of cardiac arrest, results in improved 48-hour survival and improves postresuscitation cardiac function. © 2009 Elsevier Inc. All rights reserved."
}