L-NMMA (a nitric oxide synthase inhibitor) is effective in the treatment of cardiogenic shock

Background-The objective was to assess the safety and efficacy of L-NMMA in the treatment of cardiogenic shock, Methods-We enrolled 11 consecutive patients with cardiogenic shock that per sisted after >24 hours from admission, despite coronary catheterization and primary percutaneous transluminal coronary revascularization, when feasibl e, and treatment with mechanical ventilation, intraaortic balloon pump (IAB P), and high doses of catecholamines. L-NMMA was administered as an IV bolu s of 1 mg/kg and continuous drip of 1 mg . kg(-1) . h(-1) for 5 hours, Trea tment with catecholamines, mechanical ventilation, and IABP was kept consta nt throughout the study. Results-Within 10 minutes of L-NMMA administration, mean arterial blood pre ssure (MAP) increased from 76+/-9 to 109 +/- 32 mm Hg (+43%), Urine output increased within 5 hours from 63+/-25 to 156+/-63 cc/h (+ 148%). Cardiac in dex decreased during the steep increase in MAP from 2.0+/-0.5 to 1.7+/-0.4 L/(min . m(2)) (-15%); however, it gradually increased to 1.85+/-0.4 L/(min . m(2)) after 5 hours. The heart rate and the wedge pressure remained stab le, Twenty-four hours after L-NMMA discontinuation, MAP (+36%) and urine ou tput (+189%) remained increased; however, cardiac index returned to pretrea tment level. No adverse events were detected. Ten out of eleven patients co uld be weaned off mechanical ventilation and IABP, Eight patients were disc harged from the coronary intensive care unit, and seven (64%) were alive at 1-month follow-up, Conclusions-L-NMMA administration in patients with cardiogenic shock is saf e and has favorable clinical and hemodynamic effects.