Key result
Landiolol with adrenaline increases successful extubation to 69% vs 15% with adrenaline alone after swine cardiac arrest.
Why the study?
Whether early co-administration of landiolol and adrenaline during cardiopulmonary resuscitation improves successful extubation, hemodynamics, and 48-h outcomes in ventricular fibrillation was unknown.
Does early co-administration of landiolol or esmolol with adrenaline improve successful extubation in a swine model of ventricular fibrillation undergoing cardiopulmonary resuscitation?
RCT (n=39)
Investigator-blinded
1:1:1
Does early co-administration of landiolol or esmolol with adrenaline improve successful extubation in a swine model of ventricular fibrillation undergoing cardiopulmonary resuscitation?
In a swine model of ventricular fibrillation cardiac arrest, early co-administration of landiolol with adrenaline during CPR significantly improved successful extubation rates compared to adrenaline alone, though it was not statistically superior to esmolol.
Answers are grounded in this paper and cite their sources.
May improve extubation in this swine model; hypothesis-generating, does not inform clinical practice.
Purpose We examined whether early co-administration of landiolol and adrenaline improves successful extubation, hemodynamics, and 48-h outcomes in a swine ventricular fibrillation (VF) model. Methods In this prospective, randomized, investigator-blinded study, VF was electrically induced in healthy piglets and left untreated for 8 min. Thirty-nine female Landrace/Large White piglets were randomized (1:1:1): adrenaline 0.02 mg/kg plus saline, adrenaline plus esmolol 0.5 mg/kg, or adrenaline plus landiolol 0.02 mg/kg. Treatment was administered at the initiation of mechanical cardiopulmonary resuscitation (CPR), 2 min before attempting defibrillation. Primary outcome was successful extubation. Secondary outcomes included return of spontaneous circulation (ROSC), 48-h survival, 48-h survival with complete neurological recovery, and hemodynamic variables during and after CPR. Results Successful extubation occurred in 2/13 (15%) control, 6/13 (46%) esmolol, and 9/13 (69%) landiolol animals (overall p = 0.021); the rate was significantly higher with landiolol than with control (adjusted p = 0.046). ROSC rates were 46%, 69%, and 100%, respectively ( p = 0.006); 48-h survival rates were 8%, 31%, and 54% ( p = 0.046); and 48-h survival with complete neurological recovery rates were 0%, 23%, and 46% ( p = 0.022). The landiolol group had higher observed rates of ROSC and 48-h survival with complete neurological recovery than the control group; these secondary analyses were exploratory. No pairwise difference was significant for 48-h survival. Exploratory analyses during the first 4 min of CPR identified higher observed values for selected hemodynamic variables and end-tidal carbon dioxide in the landiolol group at specific time points. Esmolol had intermediate observed outcome rates. Conclusions Early administration of landiolol with adrenaline was associated with a higher successful extubation rate and better observed early CPR hemodynamics compared with adrenaline alone and had the highest rates of ROSC, 48-h survival, and 48-h survival with complete neurological recovery. Secondary-outcome findings were exploratory, and landiolol was not statistically superior to esmolol.
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Gripiotis et al. (2026) conducted an RCT in Ventricular fibrillation (swine model) (n=39). Adrenaline plus landiolol vs. Adrenaline 0.02 mg/kg plus saline (control) or adrenaline plus esmolol 0.5 mg/kg was evaluated on Successful extubation (p=0.021 (overall); 0.046 (landiolol vs control, adjusted)). Early co-administration of landiolol and adrenaline during CPR increased successful extubation compared with adrenaline alone in a swine VF model (69% vs 15%; adjusted p=0.046).
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