Norepinephrine may be preferred over epinephrine as a first-line vasopressor, and dobutamine as a first-line inotrope, for patients with cardiogenic shock, despite sparse comparative evidence.
What is the optimal use of vasopressors and inotropes in patients with cardiogenic shock?
This review highlights norepinephrine and dobutamine as first-line vasopressor and inotrope agents for cardiogenic shock, emphasizing their use as temporary bridges due to scarce evidence.
PURPOSE OF REVIEW: Data and interventional trials regarding vasopressor and inotrope use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In this article, we review the current use of vasopressor and inotrope agents during cardiogenic shock. RECENT FINDINGS: Two recent Cochrane analyses concluded that there was not sufficient evidence to prove that any one vasopressor or inotrope was superior to another in terms of mortality. A recent RCT and a meta-analysis on individual data suggested that norepinephrine may be preferred over epinephrine in patients with cardiogenic shock . For inotrope agents, when norepinephrine fails to restore perfusion, dobutamine represents the first-line agent. Levosimendan is a calcium sensitizer agent, which improves acute hemodynamics, albeit with uncertain effects on mortality. SUMMARY: When blood pressure needs to be restored, norepinephrine is a reasonable first-line agent. Dobutamine is the first-line inotrope agent wheraes levosimendan can be used as a second-line agent or preferentially in patients previously treated with beta-blockers. Current information regarding comparative effective outcomes is nonetheless sparse and their use should be limited as a temporary bridge to recovery, mechanical circulatory support or heart transplantation.
Lévy et al. (Wed,) conducted a review in Cardiogenic shock. Inotropes and vasopressors (norepinephrine, dobutamine, levosimendan) was evaluated. Norepinephrine may be preferred over epinephrine as a first-line vasopressor, and dobutamine as a first-line inotrope, for patients with cardiogenic shock, despite sparse comparative evidence.