Comparison of Landiolol and Esmolol on Haemodynamic Responses During Weaning of Intensive Care Unit Patients with Reduced Ejection Fraction after Vascular Surgery

Background: Weaning and tracheal extubation of patients after vascular surgery is a stressful procedure that triggers the sympathetic nervous system, potentially leading to deterioration of cardiac performance in patients with left ventricular dysfunction. This study compared the efficacy and safety of landiolol, a novel ultra-short-acting β1-adrenoceptor antagonist, with that of esmolol in terms of the cardiovascular response during the extubation of patients with reduced ejection fraction (EF) admitted to the intensive care unit after major vascular surgery. Methods: This single-centre, prospective, randomised, open-label study included postoperative patients with cardiac dysfunction. Patients were randomly assigned to either landiolol or esmolol. Landiolol and esmolol infusions began as soon as the respiratory weaning procedure started, and were initiated at doses of 1 and 50 µg/kg/min, respectively (up to 10 and 200 µg/kg/min, respectively). Heart rate, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure (MAP) and cardiac rhythm were recorded every minute up to 30 minutes after extubation. Results: Thirty-nine patients with cardiac dysfunction (mean [±SD] left ventricular EF 36.6 ± 7.6%; New York Heart Association Class II/III, 32/9) were infused with either landiolol (n=19; mean rate 2.0 ± 2.1 μg/kg/min) or esmolol (n=20; mean rate 150 ± 50 μg/kg/min). Mean age, left ventricular EF, New York Heart Association class and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were similar between the two groups. Landiolol produced a more rapid and substantial decrease in heart rate than esmolol (−40 ± 20 BPM versus −30 ± 16 BPM) without haemodynamic deterioration. A significant reduction in MAP was recorded in the esmolol group. Conclusion: Landiolol produced a more rapid and potent reduction in heart rate than esmolol. A significant reduction in MAP was only seen in the esmolol group.