Amrinone significantly increased cardiac index (1.38 vs 0.69 L/min/m2, P<0.05) and right ventricular ejection fraction compared to dobutamine during weaning from cardiopulmonary bypass.
RCT (n=20)
Double-blind
Randomized
Does amrinone improve ventricular function and pulmonary pressures compared to dobutamine in patients with severe pulmonary hypertension weaning from cardiopulmonary bypass?
In patients with severe pulmonary hypertension undergoing mitral valve replacement, amrinone improves cardiac index and right ventricular ejection fraction while reducing pulmonary arterial pressures more effectively than dobutamine during weaning from cardiopulmonary bypass.
Absolute Event Rate: 1.38% vs 0.69%
p-value: p=< 0.05
We compared the relative effects of dobutamine (5 micrograms/kg/min) and amrinone (1.0 mg/kg bolus followed by 10 micrograms/kg/min) on right and left ventricular function and pulmonary arterial pressures during weaning from cardiopulmonary bypass in patients with a mean preoperative pulmonary pressure > 30 mmHg. Twenty patients scheduled for mitral valve replacement were studied in a prospective, randomized, double-blind trial. Patients receiving amrinone had a greater increase in cardiac index (CI) of 1.38 (+/-0.95) litre/min/m2 at separation vs 0.69 (+/-0.63) litre/min/m2 in the dobutamine group (P < 0.05). The amrinone group also had a greater increase in right ventricular ejection fraction (0.15 +/- 0.08 at separation from cardiopulmonary bypass versus an increase of 0.04 +/- 0.11 in those receiving dobutamine; P < 0.005). Amrinone produced a larger decrease in pulmonary artery wedge pressure 8.0 (+/-4.4) mmHg vs 0.75 (+/-6.6) mmHg at separation; pulmonary artery systolic and diastolic pressures also were reduced more in the amrinone group. There were no differences in heart rate, mean arterial pressure, central venous pressure and right ventricular stroke work index between patient groups. In the doses chosen, the use of amrinone compared to dobutamine was associated with a reduction in pulmonary arterial pressures and an increase in cardiac index and right ventricular ejection fraction after separation from bypass in patients with severe preoperative pulmonary hypertension.
Jenkins et al. (1997) conducted an RCT in Severe pulmonary hypertension after cardiopulmonary bypass (n=20). Amrinone vs. Dobutamine (5 micrograms/kg/min) was evaluated on Increase in cardiac index (CI) at separation (p=< 0.05). Amrinone significantly increased cardiac index (1.38 vs 0.69 L/min/m2, P<0.05) and right ventricular ejection fraction compared to dobutamine during weaning from cardiopulmonary bypass.