Vasopressors in Cardiogenic Shock: Which One Is Best?

Dopamine has fallen out of favor for treatment of cardiogenic shock, but which vasopressor regimen should replace it? In an open randomized study in France, 30 consecutive patients in an intensive care unit who had cardiogenic shock (cardiac index <2.2 L/minute/m²; mean arterial pressure <60 mm Hg) received titrated infusions of either norepinephrine-dobutamine or epinephrine. Patients were eligible if they were unresponsive to dopamine-dobutamine combination therapy and the etiology of shock was not related to acute coronary syndrome.

Overall, 10 of 15 patients in the epinephrine group and 11 of 15 in the norepinephrine-dobutamine group survived. Hemodynamic measurements, including cardiac index, were similar between groups. However, epinep…