Abstract
Novel therapy for cardiogenic shock
Highlights
A study to assess the safety and efficacy of L-NMMA in the treatment of cardiogenic shock
Cardiogenic shock defined as persistent unaugmented systolic blood pressure (BP) < 100 mm Hg, accompanied by pulmonary congestion, cardiac index (CI) < 2.5 L/min/m2 and wedge pressure > 15 mm Hg despite therapy
Ten of the eleven patients were weaned off ventilation and intra-aortic balloon pump (IABP); eight were discharged from the coronary care unit and seven were alive at the 1 month follow-up
Summary
Cardiogenic shock complicates acute myocardial infarction (AMI) and carries a high mortality rate despite therapy. Conventional therapy includes coronary revascularisation, afterload reduction, ionotropes and mechanical adjuncts including ventilation and intra-aortic balloon pump (IABP). Nitric oxide (NO) is involved in vasodilation. In this uncontrolled trial, NG-monomethyl-L-arginine (LNMMA), a nonspecific nitric oxide synthetase inhibitor, was administered to promote vasoconstriction in order to augment blood pressure (BP). There were no untoward effects or deaths directly attributable to the drug, and 10 of the 11 patients showed improvement. As the authors themselves point out, this is a preliminary report of a drug showing promise which needs to be studied further
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