[Differential therapy of cardiogenic shock with dopamine/milrinone in comparison with dopamine/dobutamine]

Abstract

In cardiogenic shock, combined pharmacotherapy with dopamine/dobutamine was being used as a standard regimen and was compared to dopamine/milrinone in this study. In a total of 20 patients with persistent hemodynamic depression despite mechanical ventilation plus dopamine (10-12 micrograms/kg/min) and nitroglycerin (33 micrograms/min) infusions additional therapy with dobutamine (maximal dose: 9 micrograms/kg/min; n = 10) or milrinone (0.5 microgram/kg/min; n = 10) was started. Dobutamine induced an increase of cardiac index (2.0 +/- 0.1 to 2.9 +/- 0.21/min/m2; p < 0.01; mean +/- SEM) and heart rate (96 +/- 6 to 117 +/- 5 min-1; p < 0.05) while mean arterial pressure (75 +/- 2 to 71 +/- 4 mm Hg) and pulmonary capillary wedge pressure (21 +/- 2 to 19 +/- 2 mm Hg) hardly changed. The rate-pressure product rose from 10790 +/- 684 to 13234 +/- 678 mm Hg/ min (p < 0.05). Milrinone had a comparable effect on cardiac index (2.0 +/- 0.1 to 2.6 +/- 0.1 I/min/m2; p < 0.01) but induced a minor change in heart rate (94 +/- 6 to 104 +/- 8 min-1; p < 0.05) and a more pronounced decrease in mean arterial pressure (77 +/- 2 to 65 +/- 2 mm Hg; p < 0.01) and pulmonary capillary wedge pressure (24 +/- 2 to 17 +/- 1 mm Hg; p < 0.01). The rate-pressure product declined (11033 +/- 711 to 10555 +/- 929 mm Hg/min). In comparison, dopamine/milrinone appeared to be advantageous in terms of pre- and afterload reduction and myocardial oxygen demand. However, the concomitant decline in arterial pressure might impair end-organ perfusion.