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July 14, 2020European Heart Journal Acute Cardiovascular CareOpen Access

Inhaled nitric oxide has pulmonary vasodilator efficacy both in the immediate and prolonged phase of acute pulmonary embolism

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Why the study?

Inhaled nitric oxide reduces right ventricular afterload in the immediate phase of acute PE, but whether it has pulmonary vasodilator efficacy in both the immediate and prolonged phase was unknown.

Does inhaled nitric oxide improve pulmonary hemodynamics in a porcine model of acute pulmonary embolism?

Population

18 anesthetized pigs in a porcine model of intermediate-risk PE

Comparison

iNO at 40 ppm vs vehicle vs sham

Design

Randomized preclinical animal study

Follow-up

12 hours

Key result

Inhaled nitric oxide significantly reduced mean pulmonary artery pressure at 12 hours compared to vehicle in a porcine model of acute pulmonary embolism (-3.5 vs 0.5 mmHg, p < 0.0001).

Authors

AKAnders KramerCMChristian Schmidt MortensenJSJacob Gammelgaard Schultz

Discussion

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Overview

Hypothesis-generating for inhaled nitric oxide in acute pulmonary embolism; human trials needed before clinical consideration.

Study Design

Type

RCT (n=18)

Randomization

randomized

Structured PICO

Does inhaled nitric oxide improve pulmonary hemodynamics in a porcine model of acute pulmonary embolism?

P
Population
18 anesthetized pigs in a model of intermediate-risk acute pulmonary embolism, evaluated over 12 hours.
I
Intervention
Inhaled nitric oxide (iNO) at 40 ppm at one, three, six, nine and 12 hours after onset of PE
C
Comparator
Vehicle animals (n=6) receiving PE but no active treatment, and sham animals (n=6) receiving neither PE nor treatment
O
Outcome
Mean pulmonary artery pressure (mPAP), pulmonary vascular resistance, and right ventricular arterial elastancesurrogate

Main Result

Absolute Event Rate: -3.5% vs 0.5%

p-value: p=<0.0001

Inhaled nitric oxide effectively reduces pulmonary artery pressure in both the immediate and prolonged phases of acute pulmonary embolism in a porcine model.

Cite This Study

Kramer et al. (2020) conducted an RCT in acute pulmonary embolism (n=18). Inhaled nitric oxide (iNO) vs. Vehicle (no active treatment) and sham was evaluated on mean pulmonary artery pressure (mPAP) reduction at 12 hours (p=<0.0001). Inhaled nitric oxide significantly reduced mean pulmonary artery pressure at 12 hours compared to vehicle in a porcine model of acute pulmonary embolism (-3.5 vs 0.5 mmHg, p < 0.0001).

synapsesocial.com/papers/6a6a0399ba3b67e10e44808fhttps://doi.org/10.1177/2048872620918713
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