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Vasoactive pharmacologic therapy in cardiogenic shock: a critical review

Rasha Kaddoura1, Amr Elmoheen2, Ehab Badawy2

  • 1Heart Hospital Pharmacy, Hamad Medical Corporation, Doha, Qatar.

Journal of Drug Assessment
|August 5, 2021
PubMed

Insights

Vasoactive medications like vasopressors and inotropes are crucial for treating cardiogenic shock (CS). However, evidence quality varies, highlighting the need for further research into these vital treatments.

Area of Science:

  • Cardiology
  • Pharmacology
  • Critical Care Medicine

Background:

  • Cardiogenic shock (CS) is a severe condition with high mortality.
  • Vasoactive drugs (vasopressors, inotropes) are primary treatments to enhance cardiac output and blood pressure.
  • These agents aim to improve end-organ perfusion and prevent organ failure.

Purpose of the Study:

  • To critically review randomized studies on vasoactive agents in CS.
  • To determine specific indications for each vasoactive agent.
  • To assess the methodological quality of existing research.

Main Methods:

  • Conducted a PubMed search for randomized controlled trials (RCTs) on CS vasoactive therapy.
  • Included nine RCTs involving 2388 patients, primarily in acute myocardial infarction settings.
  • Assessed study quality using the Jadad scale.

Main Results:

  • Evaluated comparisons including norepinephrine vs. dopamine, epinephrine vs. norepinephrine, and levosimendan vs. dobutamine.
  • Mean Jadad score was 3.33, indicating variable methodological quality.
  • Only three studies achieved a perfect Jadad score of 5.

Conclusions:

  • Evidence on vasoactive agents in CS has uncertainties due to variable study quality.
  • Conducting clinical trials in CS is inherently challenging.
  • Vasopressors and inotropes remain essential due to a lack of alternatives.
Abstract

Keywords:
Hemodynamic measuresinodilatorinotropelevosimendanmortalitynitric oxide synthase inhibitorsvasodilatorvasopressor

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