vasopressors in shock

31 Jul

De Backer D et al.:

Question: In the treatment of shock, is one vasopressor more efficacious than another?

Methods:

RCT all comers with shock were assigned to receive either dopamine or norepinephrine as first-line vasopressor therapy.

When hemodynamic monitoring could not be met, open label epi, norepi, or vasopressin was added.

The primary outcome was the rate of death at 28 days; secondary end points included the occurrence of adverse events.

Results:

There was no significant between-group difference in the rate of death at 28 days (52.5% in the dopamine group and 48.5% in the norepinephrine group; odds ratio with dopamine, 1.17; 95% confidence interval, 0.97 to 1.42; P=0.10).

However, there were more arrhythmic events among the patients treated with dopamine than among those treated with norepinephrine (207 events [24.1%] vs. 102 events [12.4%], P<0.001).

Teaching point: While both dopamine and norepi had no change in mortality, dopamine was associated with statistically more adverse effects (usually afib) and dopamine pts more often had to be put on open label second agent.

Submitted by W. Rushton.

Reference(s): De Backer D et al. “Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010 Mar 4;362(9):779-89.; picture

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