Why the study?
Concomitant vasoactive drugs are often needed to maintain perfusion pressure during Impella CP support in AMI and cardiogenic shock, but their comparative effects on cardiac work and end-organ perfusion remain to be determined.
Does the choice of vasoactive agent (epinephrine, dopamine, norepinephrine, phenylephrine) improve end-organ perfusion without excessively increasing cardiac work in a porcine model of cardiogenic shock supported by Impella CP?
Does the choice of vasoactive agent (epinephrine, dopamine, norepinephrine, phenylephrine) improve end-organ perfusion without excessively increasing cardiac work in a porcine model of cardiogenic shock supported by Impella CP?
In a porcine model of cardiogenic shock supported by Impella CP, catecholamines improved end-organ perfusion at the cost of increased cardiac work, whereas phenylephrine increased cardiac work without improving perfusion.
May increase cardiac work in Impella-supported porcine shock; leaves open optimal vasoactive strategy for human trials.
BACKGROUND: Concomitant vasoactive drugs are often required to maintain adequate perfusion pressure in patients with acute myocardial infarction (AMI) and cardiogenic shock (CS) receiving hemodynamic support with an axial flow pump (Impella CP). OBJECTIVE: To compare the effect of equipotent dosages of epinephrine, dopamine, norepinephrine, and phenylephrine on cardiac work and end-organ perfusion in a porcine model of profound ischemic CS supported with an Impella CP. METHODS: ), jugular bulb, and renal vein. Treatment effects were evaluated using multilevel mixed-effects linear regression. RESULTS: (p = 0.063) and increased arterial lactate levels (p = 0.002). CONCLUSION: Catecholamines increased end-organ perfusion at the expense of increased cardiac work, most by dopamine. However, phenylephrine increased cardiac work with no increase in end-organ perfusion.
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Udesen et al. (2020) studied this question.
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