Verapamil improves cardiac function and increases survival in canine E. coli endotoxin shock

The effects of verapamil, a calcium antagonist, on survival and on hemodynamic and metabolic parameters were studied in canines administered E. coli endotoxin. Shams, endotoxin controls, and endotoxin-shocked dogs treated with a 4-hour infusion of verapamil were studied. The animals were anesthetized, catheters and endotracheal tube were inserted, and an IV infusion was started after administration of endotoxin. All dogs were kept on a respirator for 4 hours while measurements were taken; they were then extubated and returned to their cages. Survival was considered permanent by 7 days. Eight of 13 treated dogs survived, in contrast with only one of 14 controls. Treated dogs had significantly higher cardiac index (4.64 vs 3.62 L/min/m2), pulmonary artery pressure (16 vs 13 mmHg), and left ventricular stroke work (44.3 vs 29.7 gm/m2 beat), and significantly lower heart rate and systemic vascular resistance at 4 hours. Serum glucose, acid phosphatase, pH, and Hct were also significantly improved by verapamil treatment.