Table 2.
Summary of comparative effectiveness animal studies evaluating vasopressors and inotropes in beta-blocker poisoning.
| Reference | Model** | Treatment arms | Results |
|---|---|---|---|
| Love et al. [15] | Canine |
Placebo (n = 6) Glucagon (n = 6) Amrinone (n = 6) |
Amrinone and glucagon effective in reversing depressed ventricular pressures, cardiac output, and stroke volume compared with placebo, only glucagon improved heart rate |
| Love et al. [22] | Canine | Amrinone + glucagon (n = 6)* | Addition of amrinone to glucagon had a detrimental effect on MAP |
| Sato et al. [23] | Canine |
Placebo (n = 3) Glucagon (n = 5) Milrinone (n = 5) |
Milrinone and glucagon both superior to placebo, hemodynamic parameters favor milrinone |
| Sato et al. [24] | Canine |
Placebo (n = 5) Glucagon (n = 5) Milrinone (n = 5) Glucagon + milrinone (n = 5) |
No evaluation of survival. All arms improved over placebo; combination therapy resulted in undesired tachycardia |
| Toet et al. [13] | Rat |
Placebo (n = 10) Isoproterenol (n = 10) Isoproterenol + glucagon (n = 10) Isoproterenol + dopamine (n = 10) |
Survival not improved over placebo in any arm, but reduced in the isoproterenol + dopamine group |
| Toet et al. [14] | Rat and rabbit |
Placebo (n = 10 rats, 8 rabbits) Glucagon (n = 10 rats, 8 rabbits) Dopamine (n = 10 rats, 8 rabbits) Dopamine + glucagon (n = 10 rats, 8 rabbits) |
Survival not improved over placebo in any arm, but reduced in dopamine + glucagon arm in rat study |
| Kerns et al. [12] | Canine |
Placebo (n = 6) Epinephrine (n = 6) Glucagon (n = 6) HDI (n = 6) |
Survival as follows: placebo (0/6), epinephrine (1/6), glucagon (4/6), and HDI (6/6) |
| Holger et al. [6] | Porcine |
Vasopressin (n = 8) Glucagon (n = 8) |
No difference between arms |
| Uechi et al. [26] | Canine (oral carvedilol) |
Placebo (n = 6) Dobutamine (n = 6) Dopamine (n = 6) Milrinone (n = 6) |
Mortality not evaluated, hemodynamic parameters favor milrinone |
| Holger et al. [11] | Porcine |
Vasopressin + epinephrine (n = 5) HDI (n = 5) |
Significantly lower survival with vasopressors |
| Leppikangas et al. [25] | Porcine |
Placebo (n = 6) Dobutamine (n = 9) Levosimendan (n = 9) |
No difference in survival between placebo and dobutamine, all pigs receiving levosimendan lived |
| Kalam and Graudins [27] | Rat (IV metoprolol) |
Placebo (n = 10) Epinephrine (n = 10) Levosimendan (n = 20) |
Improved survival with levosimendan over control but not epinephrine |
| Kalam and Graudins [28] | Rat |
Placebo (n = 10) Epinephrine (n = 10) Levosimendan (n = 50) |
No difference in survival between any groups |
| Katzung et al. [10] | Porcine |
HDI (n = 5) HDI + norepinephrine (n = 5) Norepinephrine + epinephrine (n = 5) |
Significantly reduced survival with vasopressors |
*Results compared with data from Love et al. [15]
**All models in table involve IV propranolol, except as noted