Efficacy of enoximone in the management of refractory low-output states following cardiac surgery

Fifteen consecutive patients with post-cardiac surgery low-output states refractory to catecholamine inotropic support and intra-aortic balloon counter-pulsation (seven patients), were given enoximone (MDL 17,043, a phosphodiesterase inhibitor), 1 to 2 mg/kg, as a slow intravenous bolus injection, followed by a continuous infusion of 3 to 10 microg/kg/min. Enoximone resulted in a marked improvement in clinical and hemodynamic conditions. Despite the severity of their initial status, all the patients survived their acute circulatory failure and all but two were discharged from the hospital. Hemodynamic improvement was observed as early as 15 minutes after the drug administration and reflected the previously reported inotropic and vasodilatory properties of enoximone. No serious adverse effects were observed. Enoximone thus appears safe and effective in the management of post-cardiac surgery low-output states. Its effects are additive to those of high-dose catecholamines.