Network Meta-Analysis of the Safety of Drug Therapy for Cardiogenic Shock

Abstract

Objectives: (1) To conduct a network meta-analysis of clinical drugs used for cardiogenic shock and (2) provide evidence for the selection of medication for the treatment of this condition.

Methods: PubMed, EMBASE, Cochrane library, China HowNet (CNKI), Wanfang database, and Weipu database were searched using keywords Dopamine, Dobutamine, Epinephrine, Adrenaline, Norepinephrine, Noradrenaline, Milrinone, Natriuretic peptide, Recombinant human brain natriuretic peptide, Levosimendan, Cardiac shock, and Cardiogenic shock. We select literature according to prespecified inclusion and exclusion criteria and record data such as drug type, mortality, and adverse reactions.

Results: Twenty-eight of 1387 articles met inclusion criteria, comprising 1806 patients who suffered from cardiogenic shock. Dopamine, dobutamine, epinephrine, norepinephrine, milrinone, recombinant human brain natriuretic peptide, and levosimendan were all commonly used in the treatment of cardiogenic shock. Milrinone was most effective at reducing mortality and had the lowest incidence of adverse reactions.

Conclusion: This network meta-analysis demonstrated that milrinone was the most effective medication at reducing mortality and adverse events in patients suffering from cardiogenic shock.

Figure 1

Literature screening process.

Figure 2

Network diagram of case fatality rate. Note: a, recombinant human brain natriuretic peptide; b, conventional treatment; c, dopamine; d, dobutamine; e, epinephrine; f, norepinephrine; g, milrinone; h, levosimendan.

Figure 3

Network diagram of incidence of adverse reactions. Note: a, recombinant human brain natriuretic peptide; b, conventional treatment; c, dopamine; d, dobutamine; e, epinephrine; f, norepinephrine; g, milrinone; h, levosimendan.

Figure 4

Funnel plot of case fatality rate for outcome indicator.

Figure 5

Funnel plot of incidence of adverse reactions for outcome indicators.