No Difference Between Dobutamine and Milrinone in Managing Cardiogenic Shock

The data to guide use of inotropes for patients in cardiogenic shock are limited. Using dobutamine (a β-1 and β-2 agonist) or milrinone (a phosphodiesterase-3 inhibitor) usually based is on provider preference. Milrinone offers theoretical advantages (e.g., less effect on pulmonary vascular resistance, fewer arrythmias), but these have not been demonstrated in a clinical trial.

Investigators in Canada randomized 192 patients with cardiogenic shock to treatment with protocolized dosing of either dobutamine or milrinone. Most patients had ischemic cardiomyopathy with an average ejection fraction of 25%. The composite primary outcome was death, cardiac arrest, mechanical circulatory support, cardiac transplant, stroke, myocardial infarction, or…