Related Experiment Video
Updated: Nov 20, 2025
Cardiac Stress Test Induced by Dobutamine and Monitored by Cardiac Catheterization in Mice
Published on: February 10, 2013
Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial
Rafael Alves Franco1, Juliano Pinheiro de Almeida1, Giovanni Landoni2,3
1Intensive Care Unit, Cancer Institute (ICESP), University of Sao Paulo, São Paulo, Brazil.
Insights
A dobutamine-sparing strategy in cardiac surgery patients was found to be noninferior to the standard inotrope-to-all approach. This finding suggests that reducing dobutamine use may be a safe alternative, warranting further investigation into optimizing inotrope administration.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Inotropes are often administered to all patients undergoing cardiac surgery to prevent low cardiac output syndrome.
- Detrimental effects of inotropes are known, yet evidence for a tailored, inotrope-sparing approach is lacking.
- Standard practice often involves routine inotrope use despite potential risks.
Purpose of the Study:
- To assess the noninferiority of a dobutamine-sparing strategy compared to a routine dobutamine administration in cardiac surgery patients with normal ejection fraction.
- To evaluate if a patient-tailored approach guided by hemodynamic evidence is as effective as administering dobutamine to all patients.
Main Methods:
- A randomized controlled noninferiority trial was conducted.
- 160 patients undergoing cardiac surgery with normal ejection fraction were randomized.
- One group received a dobutamine-sparing strategy, while the other received dobutamine to all.
Main Results:
- The primary composite endpoint (30-day mortality or major cardiovascular complications) occurred in 31% of the dobutamine-sparing group and 34% of the dobutamine-to-all group (p=0.74).
- No significant differences were observed in acute kidney injury, prolonged mechanical ventilation, or length of stay between the groups.
- The dobutamine-sparing strategy was noninferior to the dobutamine-to-all strategy.
Conclusions:
- A dobutamine-sparing strategy did not increase mortality or major cardiovascular events compared to routine dobutamine administration in this patient population.
- Reducing inotrope use in cardiac surgery may be a viable alternative to current standard practices.
- Further research is necessary to confirm the benefits of reduced inotrope administration in cardiac surgery outcomes.
Background:
The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine).
Results:
A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay.
Discussion:
Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801.
Related Concept Videos
01:22Heart Failure Drugs: β-Blockers
01:26Heart Failure Drugs: Inotropic Agents