Key result
Milrinone linked to ~16% lower mortality vs dobutamine in cardiogenic shock.
Why the study?
Inotropic support is commonly used in cardiogenic shock, but high-quality data guiding the choice between dobutamine and milrinone remain limited.
Does dobutamine compared to milrinone reduce all-cause in-hospital mortality in hospitalized patients with low cardiac output states or cardiogenic shock?
Meta-Analysis (n=21,084)
Does dobutamine compared to milrinone reduce all-cause in-hospital mortality in hospitalized patients with low cardiac output states or cardiogenic shock?
In patients with cardiogenic shock or low cardiac output states, limited observational data suggests milrinone may be associated with lower mortality but longer hospital stay compared to dobutamine, highlighting the need for adequately powered RCTs.
Answers are grounded in this paper and cite their sources.
Caution against preferring milrinone on observational mortality data alone; leaves open optimal inotrope choice pending RCTs in cardiogenic shock.
OBJECTIVES: Inotropic support is commonly used in patients with cardiogenic shock (CS). High-quality data guiding the use of dobutamine or milrinone among this patient population is limited. We compared the efficacy and safety of these two inotropes among patients with low cardiac output states (LCOS) or CS. DATA SOURCES: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched up to February 1, 2023, using key terms and index headings related to LCOS or CS and inotropes. DATA EXTRACTION: Two independent reviewers included studies that compared dobutamine to milrinone on all-cause in-hospital mortality, length of ICU stay, length of hospital stay, and significant arrhythmias in hospitalized patients. DATA SYNTHESIS: A total of eleven studies with 21,084 patients were included in the meta-analysis. Only two randomized controlled trials were identified. The primary outcome, all-cause mortality, favored milrinone in observational studies only (odds ratio [OR] 1.19 (95% CI, 1.02–1.39; p = 0.02). In-hospital length of stay (LOS) was reduced with dobutamine in observational studies only (mean difference –1.85 d; 95% CI –3.62 to –0.09; p = 0.04). There was no difference in the prevalence of significant arrhythmias or in ICU LOS. CONCLUSIONS: Only limited data exists supporting the use of one inotropic agent over another exists. Dobutamine may be associated with a shorter hospital LOS; however, there is also a potential for increased all-cause mortality. Larger randomized studies sufficiently powered to detect a difference in these outcomes are required to confirm these findings.
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Abdel‐Razek et al. (2023) conducted a meta-analysis in Cardiogenic shock or low cardiac output states (n=21,084). Milrinone vs. Dobutamine was evaluated on All-cause in-hospital mortality (OR 1.19, 95% CI 1.02-1.39, p=0.02). Milrinone was associated with lower all-cause mortality compared to dobutamine in observational studies of cardiogenic shock.
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