Skip to main content
SpringerLink
Log in

Inotropes and Vasoactive Agents: Differences Between Europe and the United States

  • Critical Care Anesthesia (BS Rasmussen, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review focuses on the place of vasoactive agents in the treatment of shock. We will discuss evidence and compare available guidelines and current treatment patterns between Europe and the United States (US).

Recent Findings

Retrospective data from large registries demonstrated a wide variability between physicians and hospitals in the use of vasoactive agents in the treatment of shock, especially with regard to inotropes. This is due to a paucity of evidence-based data and hence a lack of clear recommendations on how to choose one agent over another. Norepinephrine has replaced dopamine as the first-line vasopressor agent in clinical practice. In patients with acute heart failure, European physicians use more inotropes than their colleagues in the US, whereas cardiac surgical patients receive more inotropes in the US.

Summary

Overall, practice patterns between Europe and the US do not differ substantially (except for a higher use of dopamine in the US), with dobutamine and norepinephrine being the most commonly used agents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Vincent JL, De Backer D. Circulatory shock. N Engl J Med. 2013;369:1726–34.

    CAS  PubMed  Google Scholar 

  2. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New-Zealand, 2000-2012. JAMA. 2014;311:1308–16.

    CAS  PubMed  Google Scholar 

  3. Vincent JL, Ince C, Bakker J. Clinical review: circulatory shock – an update: a tribute to professor Max Harry Weil. Crit Care. 2012;16:239.

    PubMed  PubMed Central  Google Scholar 

  4. Weil MH, Shubin H. Proposed reclassification of shock states with special reference to distributive effects. Adv Exp Med Biol. 1971;23:13–23.

    CAS  PubMed  Google Scholar 

  5. Weil MH, Shubin H. The “VIP” approach to the bedside management of shock. JAMA. 1969;207:337–40.

    CAS  PubMed  Google Scholar 

  6. Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795–815.

    PubMed  PubMed Central  Google Scholar 

  7. Lambden S, Creagh-Brown BC, Hunt J, Summers C, Forni LG. Definitions and pathophysiology of vasoplegic shock. Crit Care. 2018;22:174.

    PubMed  PubMed Central  Google Scholar 

  8. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315:801–10.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369:840–51.

    CAS  PubMed  Google Scholar 

  10. Hollenberg SM, Ahrens TS, Astiz ME, Chalfin DB, Dasta JF, Heard SO, et al. Practice parameters for hemodynamic support of sepsis in adult patients.Task force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med. 1999;27:639–60.

    Google Scholar 

  11. Vincent JL. Hemodynamic support in septic shock. Intensive Care Med. 2001;27:S80–92.

    PubMed  Google Scholar 

  12. •• Rhodes A, Evand LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–77 Most recent update of the Surviving Sepsis Campaign (SSC) guidelines. Knowledge of these guidelines and recommendations is of critical importance for everyone who is involved in the management of ICU patients as studies demonstrated an association between compliance with the guidelines and patient survival.

    PubMed  Google Scholar 

  13. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary. A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2013;62:1495–539.

    Google Scholar 

  14. •• Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats ASJ, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:2129–200 The most recent update of the European guidelines for the management of patients with heart failure.

    PubMed  Google Scholar 

  15. Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, et al. Evaluation and management of right-sided heart failure: a scientific statement from the American Heart Association. Circulation. 2018;137:e578–662.

    PubMed  Google Scholar 

  16. Harjola VP, Mebazaa A, Celutkiene J, Bettex D, Bueno H, Chioncel O, et al. Contemporary management of acute right ventricular failure: a statement from the heart failure association and the working group on pulmonary circulation and right ventricular function of the European Society of Cardiology. Eur J Heart Fail. 2016;18:226–41.

    PubMed  Google Scholar 

  17. Van Diepen S, Katz J, Albert NM, Henry TD, Jacobs AK, Kilic A, et al. Contemporary management of cardiogenic shock. A scientific statement from the American Heart Association. Circulation. 2017;136:e232–68.

    PubMed  Google Scholar 

  18. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2004;30:536–55.

    PubMed  Google Scholar 

  19. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34:17–60.

    PubMed  Google Scholar 

  20. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Levy MM, Pronovost PJ, Dellinger RP, Townsend S, Resar RK, Clemmer TP, et al. Sepsis change bundles: converting guidelines into meaningful change in behavior and clinical outcome. Crit Care Med. 2004;32:S595–7.

    PubMed  Google Scholar 

  22. Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, et al. Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med. 2015;43:3–12.

    PubMed  Google Scholar 

  23. Rhodes A, Phillips G, Beale R, Cecconi M, Chiche JD, De Backer D, et al. The Surviving Sepsis Campaign bundles and outcome : results from the international multicenter prevalence study on sepsis (the IMPreSS study). Intensive Care Med. 2015;41:1620–8.

    PubMed  Google Scholar 

  24. De Backer D, Biston P, Deviendt J, Madl C, Chochrad D, Aldecoa C, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362:779–89.

    PubMed  Google Scholar 

  25. De Backer D, Aldecoa C, Njimi H, Vincent JL. Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis. Crit Care Med. 2012;40:725–30.

    PubMed  Google Scholar 

  26. Avni T, Lador A, Lev S, Leibovici L, Paul M, Grossman A. Vasopressors for the treatment of septic shock: systematic review and meta-analysis. PLoS One. 2015;10:e0129305.

    PubMed  PubMed Central  Google Scholar 

  27. Bailey AR, Burchett KR. Effect of low-dose dopamine on serum concentrations of prolactin in critically ill patients. Br J Anaesth. 1997;78:97–9.

    CAS  PubMed  Google Scholar 

  28. Fawzy A, Evans SR, Walkey AJ. Practice patterns and outcomes associated with choice of initial vasopressor therapy for septic shock. Crit Care Med. 2015;43:2141–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Sakr Y, Reinhart K, Vincent JL, Sprung CL, Moreno R, Ranieri M, et al. Does dopamine administration in shock influence outcome? Results of the sepsis occurrence in acutely ill patients (SOAP). Crit Care Med. 2006;34:589–97.

    CAS  PubMed  Google Scholar 

  30. Asfar P, Meziani F, Hamel JF, Grelon F, Megarbane B, Anguel N, et al. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014;24:1583–93.

    Google Scholar 

  31. Lamontagne F, Meade O, Hébert PC, Asfar P, Lauzier F, Seely AJE, et al. Higher versus lower blood pressure targets for vasopressor therapy in shock: a multicentre pilot randomized trial. Intensive Care Med. 2016;42:542–50.

    CAS  PubMed  Google Scholar 

  32. • Vail E, Gershengorn HB, Hua M, Walkey AJ, Rubenfeld G, Wunsch H. Association between US norepinephrine shortage and mortality among patients with septic shock. JAMA. 2017;317:1433–42 This observational study showed US physician’s preferences for the selection of alternative vasopressor agents in a period of norepinephrine shortage. Remarkably, admission to a hospital experiencing such shortage was associated with an increased rate of in-hospital mortality.

    PubMed  Google Scholar 

  33. Alaniz C, Pollard S. Vasopressor dosing in septic shock. Crit Care Med. 2013;12:e483–4.

    Google Scholar 

  34. Levy B, Bollaert PE, Charpentier C, Nace L, Audibert G, Bauer P, et al. Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism, and gastric tonometric variables in septic shock: a prospective, randomized study. Intensive Care Med. 1997;23:282–7.

    CAS  PubMed  Google Scholar 

  35. Sharshar T, Blanchard A, Paillard M, Raphael JC, Gajdos P, Annane D. Circulating vasopressin levels in septic shock. Crit Care Med. 2003;31:1752–8.

    CAS  PubMed  Google Scholar 

  36. Russell JA, Walley KR, Singer J, Gordon AC, Hébert PC, Cooper J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358:877–87.

    CAS  PubMed  Google Scholar 

  37. Vail E, GershengornH HM, Walkey A, Wunsch H. Epidemiology of vasopressin use among adults with septic shock. Ann Am Thorac Soc. 2016;13:1760–7.

    PubMed  PubMed Central  Google Scholar 

  38. Serpa Neto A, Nassar AP, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, et al. Vasopressin and terlipressin in adult vasodilatory shock : a systematic review and meta-analysis of nine randomized trials. Crit Care. 2012;16:R154.

    PubMed  PubMed Central  Google Scholar 

  39. Gordon A, Mason AJ, Thirunavukkarasu N, Perkins GD, Cecconi M, Cepkova M, et al. Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock. The VANISH randomized clinical trial. JAMA. 2016;316:509–18.

    CAS  PubMed  Google Scholar 

  40. Liu ZM, Chen J, Kou Q, Lin Q, Huang X, Tang Z, et al. Terlipressin versus norepinephrine as infusion in patients with septic shock: a multicenter, randomized, double-blinded trial. Intensive Care Med. 2018;44:1816–25.

    CAS  PubMed  Google Scholar 

  41. Khanna A, English SW, Wang XS, Ham K, Tumlin J, Szerlip H, et al. Angiotensin II for the treatment of vasodilatory shock. N Engl J Med. 2017;377:419–30.

    CAS  PubMed  Google Scholar 

  42. Vieillard-Baron A, Caille V, Charron C, Belliard G, Page B, Jardin F. Actual incidence of global left ventricular hypokinesia in adult septic shock. Crit Care Med. 2008;36:1701–6.

    PubMed  Google Scholar 

  43. Annane D, Vignon P, Renault A, Bollaert PE, Charpentier C, Martin C, et al. Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomized trial. Lancet. 2007;370:676–84.

    CAS  PubMed  Google Scholar 

  44. Zangrillo A, Putzu A, Monaco F, Oriani A, Frau G, De Luca M, et al. Levosimendan reduces mortality in patients with severe sepsis and septic shock: a meta-analysis of randomized trials. J Crit Care. 2015;30:908–13.

    CAS  PubMed  Google Scholar 

  45. • Gordon AC, Perkins GD, Singer M, McAuley DF, Orme RML, Santhakumaran S, et al. Levosimendan for the prevention of acute organ dysfunction in sepsis (LeoPARDS). N Engl J Med. 2016;375:1638–48 The largest published randomized trial on the use of levosimendan in patients with septic shock failed to demonstrate a beneficial effect. Hence, its role in the treatment of these patients is limited.

    CAS  PubMed  Google Scholar 

  46. Yancy CW, Jessup M, Boskurt B, Butler J, Casey DE, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137–61.

    PubMed  Google Scholar 

  47. • Mebazaa A, Tolppanen H, Mueller C, Lassus J, Di Somma S, Baksyte G, et al. Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance. Intensive Care Med. 2016;42:147–63 This is a very comprehensive overview of the management of patients with severe acute heart failure along the entire patient journey from pre-hospital care to hospital discharge.

    CAS  PubMed  Google Scholar 

  48. Packer M, Carver JR, Rodeheffer RJ, Ivanhoe RJ, Di Bianco R, Zeldis SM, et al. Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE study research group. N Engl J Med. 1991;325:1468–75.

    CAS  PubMed  Google Scholar 

  49. Cohn JN, Goldstein SO, Greenberg BH, Lorell BH, Bourge RC, Jaski BE, et al. A dose-dependent increase in mortality with vesnarinone among patients with severe heart failure. Vesnarinone trial investigators. N Engl J Med. 1998;339:1810–6.

    CAS  PubMed  Google Scholar 

  50. Adams J, Fonarow GC, Emerman CL, Le Jemtel TH, Costanzo MR, Abraham WT, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100.000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005;149:209–16.

    PubMed  Google Scholar 

  51. Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J. 2006;27:2725–36.

    PubMed  Google Scholar 

  52. Cuffe MS, Califf RM, Adams KF, Benza R, Bourge R, Colucci WS, et al. Short-term intravenous milrinone for acute exacerbations of chronic heart failure. A randomized controlled trial (OPTIME-CHF). JAMA. 2002;287:1541–7.

    CAS  PubMed  Google Scholar 

  53. Felker GM, Benza RL, Chandler AB, Leimberger JD, Cuffe MS, Califf RM, et al. Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study. J Am Coll Cardiol. 2003;41:997–1003.

    CAS  PubMed  Google Scholar 

  54. Elkayam U, Tasissa G, Binanay C, Stevenson LW, Gheorghiade M, Warnica JW, et al. Use and impact of inotropes and vasodilator therapy in hospitalized patients with severe heart failure. Am Heart J. 2007;153:98–104.

    PubMed  Google Scholar 

  55. Thackray S, Easthaugh J, Freemantle N, Cleland JG. The effectiveness and relative effectiveness of intravenous inotropic drugs acting through the adrenergic pathway in patients with heart failure – a meta-regression analysis. Eur J Heart Fail. 2002;4:515–29.

    CAS  PubMed  Google Scholar 

  56. Follath F, Cleland JGF, Just H, Papp JGY, Scholz H, Peuhkurinen K, et al. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomized double-blind trial. Lancet. 2002;360:196–202.

    CAS  PubMed  Google Scholar 

  57. Moiseyev VS, Poder P, Andrejevs N, Ruda MY, Golikov AP, Lazebnik LB, et al. Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with left ventricular failure due to an acute myocardial infarction. A randomized, placebo-controlled, double-blind study (RUSSLAN). Eur Heart J. 2002;23:1422–32.

    CAS  PubMed  Google Scholar 

  58. Mebazaa A, Nieminen MS, Packer M, Cohen-Solal A, Kleber FX, Pocock SJ, et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure. The SURVIVE randomized trial. JAMA. 2007;297:1883–91.

    CAS  PubMed  Google Scholar 

  59. Packer M, Colucci W, Fisher L, Massie BM, Teerlinck JR, Young J, et al. Effect of levosimendan on the short-term clinical course of patients with acutely decompensated heart failure (REVIVE). J Am Coll Cardiol. 2013;1:103–11.

    Google Scholar 

  60. Nieminen MS, Buerke M, Cohen-Solal A, Costa S, Edes I, Erlikh A, et al. The role of levosimendan in acute heart failure complicating acute coronary syndrome: a review and expert consensus opinion. Int J Cardiol. 2016;218:150–7.

    PubMed  Google Scholar 

  61. • Tarvasmäki T, Lassus J, Varpula M, Sionis A, Sund R, Kober L, et al. Current real-life use of vasopressors and inotropes in cardiogenic shock – adrenaline use is associated with excess organ injury and mortality. Crit Care. 2016;20:208 This prospective observational study in nine European countries demonstrated an independent association between the administration of epinephrine and increased mortality in patients with cardiogenic shock. The administration of dobutamine or levosimendan appeared prognostically similar.

    PubMed  PubMed Central  Google Scholar 

  62. Publication Committee for the VMAC Investigators (Vasodilation in the Management of Acute CHF). Intravenous nesiritide vs. nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA. 2002;287:1531–40.

    Google Scholar 

  63. O’Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011;365:32–43.

    PubMed  Google Scholar 

  64. • Packer M, O’Connor C, McMurray JJV, Wittes J, Abraham WT, Anker SD, et al. Effect of ularitide on cardiovascular mortality in acute heart failure. N Engl J Med. 2017;376:1956–64 This large RCT added growing body of evidence that the place of recombinant natriuretic peptides in the treatment of patients with AHF is limited, as neutral effects on patients outcome were demonstrated.

    CAS  PubMed  Google Scholar 

  65. Teerlink JR, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, et al. Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomized, placebo-controlled trial. Lancet. 2013;381:29–39.

    CAS  PubMed  Google Scholar 

  66. RELAXin in Acute Heart Failure-2 – RELAX-AHF-2. Presented by Dr. John R. Teerlink at the ESC World Congress on Acute Heart Failure, April 29, 2017, Paris, France. https://www.acc.org/latest-in-cardiology/clinical-trials/2017/05/07/16/09/relax-ahf-2.

  67. Abraham WT, Adams KF, Fonarow GC, Costanzo MR, Berkowitz RL, Le Jemtel TH, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005;46:57–64.

    PubMed  Google Scholar 

  68. Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O’Connor CM, She L, et al. Systolic blood pressure at admission, clinical characteristics, and outcome in patients hospitalized with acute heart failure. JAMA. 2006;296:2217–26.

    CAS  PubMed  Google Scholar 

  69. Partovian C, Gleim RS, Mody PS, Li SX, Wang H, Strait KM, et al. Hospital patterns of use of positive inotropic agents in patients with heart failure. J Am Coll Cardiol. 2012;60:1402–9.

    PubMed  PubMed Central  Google Scholar 

  70. Allen LA, Fonarow GC, Grau-Sepulveda MV, Hernandez AF, Peterson PN, Partovian C, et al. Hospital variation in intravenous inotrope use for patients hospitalized with heart failure: insight from Get With The Guidelines. Circ Heart Fail. 2014;7:251–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  71. Tavazzi L, Maggioni AP, Lucci D, Cacciatore G, Ansalone G, Oliva F, et al. Nationwide survey on acute heart failure in cardiology ward services in Italy. Eur Heart J. 2006;27:1207–15.

    PubMed  Google Scholar 

  72. Tanaka TD, Sawano M, Ramani R, Friedman M, Kohsaka S. Acute heart failure management in the USA and Japan: overview of practice patterns and review of evidence. ESC Heart Failure. 2018;5:932–48.

    Google Scholar 

  73. Mohan M, Hawkey S, Baig F, Choy AM, Lang CC. Underutilization of IV nitrates in the treatment of acute heart failure. Cardiovasc Ther. 2015;33:247–52.

    CAS  PubMed  Google Scholar 

  74. Mozzafarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics – 2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–360.

    Google Scholar 

  75. Mehta RH, Grab JD, O’Brien SM, Glower DD, Haan CK, Gammie JS, et al. Clinical characteristics and in-hospital outcomes of patients with cardiogenic shock undergoing coronary artery bypass surgery: insights from the Society of Thoracic Surgeons National Cardiac Database. Circulation. 2008;117:876–85.

    PubMed  Google Scholar 

  76. • Lomivorotov VV, Efremov SM, Kirov MY, Fominskiy EV, Karaskov AM. Low-cardiac-output syndrome after cardiac surgery. J Cardiothorac Vasc Anesth. 2017;31:291–308 This is an excellent review addressing all aspects of this syndrome that is commonly seen after complex cardiosurgical procedures.

    PubMed  Google Scholar 

  77. Gillies M, Bellomo R, Doolan L, Buxton B. Bench-to-bedside review: inotropic drug therapy after adult cardiac surgery – a systematic review literature. Crit Care. 2005;9:266–79.

    PubMed  Google Scholar 

  78. Bastien O, Vallet B. French multicentre survey on the use of inotropes after cardiac surgery. Crit Care. 2005;9:241–2.

    PubMed  PubMed Central  Google Scholar 

  79. Leone M, Vallet B, Teboul JL, Mateo J, Bastien O, Martin C. Survey of the use of catecholamines by French physicians. Intensive Care Med. 2004;30:984–8.

    PubMed  Google Scholar 

  80. Kastrup M, Markewitz A, Spies C, Carl M, Erb J, Grosse J, et al. Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-operative cardiac surgery patients in Germany: results from a postal survey. Acta Anaesthesiol Scand. 2007;51:347–58.

    CAS  PubMed  Google Scholar 

  81. Kastrup M, Carl M, Spies C, Sander M, Markewitz A, Schirmer U. Clinical impact of the publication of S3 guidelines for intensive care in cardiac surgery patients in Germany: results from a postal survey. Acta Anaesthesiol Scand. 2013;57:206–13.

    CAS  PubMed  Google Scholar 

  82. Müller M, Junger A, Bräu M, Kwapisz MM, Schindler E, Akintürk H, et al. Incidence and risk calculation of inotropic support in patients undergoing cardiac surgery with cardiopulmonary bypass using an automated anaesthesia record-keeping system. Br J Anaesth. 2002;89:398–404.

    PubMed  Google Scholar 

  83. Sponholz C, Schelenz C, Reinhart K, Schirmer U, Stehr SN. Catecholamine and volume therapy for cardiac surgery in Germany – results from a postal survey. PLoS One. 2014;9:e103996.

    PubMed  PubMed Central  Google Scholar 

  84. Nielsen DV, Johnsen SP, Madsen M, Jakobsen CJ. Variation in use of perioperative inotropic support therapy in cardiac surgery: time for reflection? Acta Anaesthesiol Scand. 2011;55:352–8.

    CAS  PubMed  Google Scholar 

  85. Landoni G, Lomivorotov VV, Alvaro G, Lobreglio R, Pisano A, Guarracino F, et al. Levosimendan for hemodynamic support after cardiac surgery (CHEETAH). N Engl J Med. 2017;376:2021–31.

    CAS  PubMed  Google Scholar 

  86. Butterworth JF, Legault C, Royster RL, Hammon JW. Factors that predict the use of positive inotropic drug support after cardiac valve surgery. Anesth Analg. 1998;86:461–7.

    PubMed  Google Scholar 

  87. Hernandez AF, Li S, Dokholyan RS, O’Brien SM, Ferguson TB, Peterson ED. Variation in perioperative vasoactive therapy in cardiovascular surgical care: data from the Society of Thoracic Surgeons. Am Heart J. 2009;158:47–52.

    PubMed  Google Scholar 

  88. Mentzer RM, Oz MC, Sladen RN, Graeve AH, Hebeler RF, Luber JM, et al. Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery. J Am Coll Cardiol. 2007;49:716–26.

    CAS  PubMed  Google Scholar 

  89. Mebazaa A, Pitsis AA, Rudiger A, Toller W, Longrois D, Rickstein SE, et al. Clinical review: practical recommendations on the management of perioperative heart failure in cardiac surgery. Crit Care. 2010;14:201.

    PubMed  PubMed Central  Google Scholar 

  90. Royster RL, Butterworth JF, Prough DS, Johnston WE, Thomas JL, Hogan PE, et al. Preoperative and intraoperative predictors of inotropic support and long-term outcome in patients having coronary artery bypass grafting. Anesth Analg. 1991;72:729–36.

    CAS  PubMed  Google Scholar 

  91. McKinlay KH, Schinderle DB, Swaminathan M, Podgoreanu MV, Milano CA, Messier RH, et al. Predictors of inotrope use during separation from cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2004;18:404–8.

    PubMed  Google Scholar 

  92. Fleming GA, Murray KT, Yu C, Byrne JG, Greelish JP, Petracek MR, et al. Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery. Circulation. 2008;118:1619–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  93. Fellahi JL, Parienti JJ, Hanouz JL, Plaud B, Riou B, Ouattara A. Perioperative use of dobutamine in cardiac surgery and adverse cardiac outcome. Anesthesiology. 2008;108:979–87.

    CAS  PubMed  Google Scholar 

  94. Shahin J, deVarennes B, Tse CW, Amarica DA, Dial S. The relationship between inotrope exposure, six-hour postoperative physiological variables, hospital mortality and renal dysfunction in patients undergoing cardiac surgery. Crit Care. 2011;15:R162.

    PubMed  PubMed Central  Google Scholar 

  95. Nielsen DV, Hansen MK, Johnsen SP, Hansen M, Hindsholm K, Jakobsen CJ. Health outcomes with and without use of inotropic therapy in cardiac surgery. Anesthesiology. 2014;120:1098–108.

    PubMed  Google Scholar 

  96. Fellahi JL, Fischer MO, Daccache G, Gerard JL, Hanouz JL. Positive inotropic agents in myocardial ischemia-reperfusion injury. Anesthesiology. 2013;118:1460–5.

    PubMed  Google Scholar 

  97. Majure DT, Greco T, Greco M, Ponschab M, Biondi-Zoccai G, Zangrillo A, et al. Meta-analysis of randomized controlled trials of effect of milrinone on mortality in cardiac surgery: an update. J Cardiothorac Vasc Anesth. 2013;27:220–9.

    CAS  PubMed  Google Scholar 

  98. Uhio M, Egi M, Wakabayashi J, Nishimura T, Miyatake Y, Obata N, et al. Impact of milrinone administration in adult cardiac surgery patients: updated meta-analysis. J Cardiothorac Vasc Anesth. 2016;30:1454–60.

    Google Scholar 

  99. • Nielsen DV, Torp-Pedersen C, Skals RK, Gerds TA, Karaliunaite Z, Jakobsen CJ. Intraoperative milrinone versus dobutamine in cardiac surgery patients: a retrospective cohort study on mortality. Crit Care. 2018;22:51 This retrospective study further questions the benefit of milrinone administration over dobutamine in cardiac surgical patients.

    PubMed  PubMed Central  Google Scholar 

  100. •• Faisal SA, Apatov DA, Ramakrishna H, Weiner MM. Expert review. Levosimendan in cardiac surgery: evaluating the evidence. J Cardiothorac Vasc Anesth. 2018;33:1146–58. https://doi.org/10.1053/j.jvca.2018.05.035. An outstanding and very recent publication that summarizes all the available evidence on the use of levosimendan in cardiac surgical patients.

    Article  CAS  PubMed  Google Scholar 

  101. Putzu A, Clivio S, Belletti A, Cassina T. Perioperative levosimendan in cardiac surgery: a systematic review with meta-analysis and trial sequential analysis. Int J Cardiol. 2018;251:22–31.

    PubMed  Google Scholar 

  102. Mehta RH, Leimberger JD, van Diepen S, Meza J, Wang A, Jankowich R, et al. Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery. N Engl J Med. 2017;376:2032–42.

    CAS  PubMed  Google Scholar 

  103. Cholley B, Pharm TC, Grosjean S, Amour J, Ouattara A, Villacorta J, et al. Effect of levosimendan on low cardiac output syndrome in patients with low ejection fraction undergoing coronary artery bypass grafting with cardiopulmonary bypass. The LICORN randomized clinical trial. JAMA. 2017;318:548–56.

    CAS  PubMed  PubMed Central  Google Scholar 

  104. • Guarracino F, Heringlake M, Cholley B, Bettex D, Bouchez S, Lomivorotov VV, et al. Use of levosimendan in cardiac surgery: an update after LEVO-CTS, CHEETAH and LICORN trials in the light of clinical practice. J Cardiovasc Pharmacol. 2018;71:1–9 A critical interpretation of the disappointing results that were showed by the latest RCT’s with levosimendan administration in the perioperative period in cardiac surgery. The authors highlighted the importance of patient selection, timing, and dosing of its administration.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Dieter Van Beersel & Steffen Rex

  2. Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium

    Steffen Rex

Authors
  1. Dieter Van Beersel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steffen Rex
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dieter Van Beersel.

Ethics declarations

Conflict of Interest

Dieter Van Beersel declares that he has no conflict of interest.

Steffen Rex has received speaker’s honoraria from Orion Pharma and Edwards Lifesciences.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Critical Care Anesthesia

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Van Beersel, D., Rex, S. Inotropes and Vasoactive Agents: Differences Between Europe and the United States. Curr Anesthesiol Rep 9, 202–213 (2019). https://doi.org/10.1007/s40140-019-00323-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40140-019-00323-2

Keywords

Search

Navigation