Use of nitric oxide for decompensated right ventricular failure and circulatory shock after cardiac arrest

King, R.; Esmail, M.; Mahon, Suzanne M.; Dingley, John; Dwyer, Scott

doi:10.1093/bja/85.4.628

Cited by 7 publications

(3 citation statements)

References 11 publications

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“…Institution of iNO treatment has been described previously for treatment of pulmonary embolus, pulmonary hypertension and AFE [8, 14]. In this case the ability to perform and evaluate a transthoracic ultrasound rapidly both confirmed the diagnosis and the response to iNO treatment.…”

Section: Discussionmentioning

confidence: 54%

Inhaled nitric oxide might be a contributing tool for successful resuscitation of cardiac arrest related to pulmonary hypertension

Bredmose

Buskop

Lømo³

2019

Scand J Trauma Resusc Emerg Med

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We describe a case where inhaled nitric oxide (iNO) was successfully initiated during cardiopulmonary resuscitation (CPR) in a younger patient with cardiac arrest related to pulmonary hypertension after disseminated intravascular coagulation (DIC) postpartum bleeding and hysterectomy. This case illustrates that iNO might be a potential lifesaving tool for resuscitation of patients with cardiac arrest related to pulmonary hypertension, for whom most other resuscitation strategies often are futile. Electronic supplementary material The online version of this article (10.1186/s13049-019-0602-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 54%

Inhaled nitric oxide might be a contributing tool for successful resuscitation of cardiac arrest related to pulmonary hypertension

Bredmose

Buskop

Lømo³

2019

Scand J Trauma Resusc Emerg Med

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“…This minimizes systemic vasodilatation, although it necessitates continuous delivery into the ventilator circuit [206]. NO selectively reduces PVR and improves CO in PAH [212], secondary PH [205,213,214], acute PE [215,216], ischemic RV dysfunction [217,218], and postsurgical PH [202,219-234]. NO also improves oxygenation [235], RVEF, and reduces vasopressor requirements in PH after cardiac surgery [236], especially in patients with higher baseline PVR [237], with no augmented effect seen at doses above 10 ppm in these patients [238].…”

Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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IntroductionPulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on the management of PH and RV failure in adult critical care.MethodsA systematic review was performed, based on a search of the literature from 1980 to 2010, by using prespecified search terms. Relevant studies were subjected to analysis based on the GRADE method.ResultsClinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. The following GRADE recommendations (evidence level) are made in patients with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low-quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low-dose vasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation (low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vascular dysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type III inhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation (low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance. 7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR and improve RV function, notably in pulmonary vascular dysfunction after cardiac surgery, and that the side-effect profile is reduced by using inhaled rather than systemic agents. 8) A weak recommendation (very-low-quality evidence) is made that mechanical therapies may be useful rescue therapies in some settings of pulmonary vascular dysfunction awaiting definitive therapy.ConclusionsThis systematic review highlights that although some recommendations can be made to guide the critical care management of pulmonary vascular and right ventricular dysfunction, within the limitations of this review and the GRADE methodology, the quality of the evidence base is generally low, and further high-quality research is needed.

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“…The crucial role of endothelium-derived NO in the maintenance of a normal cardiac function and the inhibition of adverse ventricular remodeling is well established [17,18]. In line with this, it has been shown that administration of NO improves the left ventricle diastolic function in HF patients [19] and that chronic inhibition of the endogenous NO production is associated with severe myocardial fibrosis in animal models [20].…”

Section: Discussionmentioning

confidence: 95%

Serum concentrations of asymmetric and symmetric dimethylarginine are associated with mortality in acute heart failure patients

Potočnjak

Radulović

Degoricija

et al. 2018

International Journal of Cardiology

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Use of nitric oxide for decompensated right ventricular failure and circulatory shock after cardiac arrest

Cited by 7 publications

References 11 publications

Inhaled nitric oxide might be a contributing tool for successful resuscitation of cardiac arrest related to pulmonary hypertension

Inhaled nitric oxide might be a contributing tool for successful resuscitation of cardiac arrest related to pulmonary hypertension

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Serum concentrations of asymmetric and symmetric dimethylarginine are associated with mortality in acute heart failure patients

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