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Inotropic Agents and Vasopressors in the Treatment of Cardiogenic Shock

  • Cardiogenic Shock: Progress in Mechanical Circulatory Support (JE Rame, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Background

Worldwide, cardiogenic shock (CS) is the leading cause of death in patients admitted with an acute myocardial infarction (AMI). CS is characterised by reduced cardiac output secondary to systolic dysfunction which can lead to multi-organ failure. The mainstay of medical treatment in CS are inotropes and vasopressors to improve cardiac output. However, current clinical guidelines do not direct clinicians as to which agents to use and in what combinations. This article aims to review the current evidence on the management of CS with a major focus on the use of inotropes and vasopressors.

Method

A literature review was conducted analysing published literature from the following databases: PubMed, MedLine, Cochrane Library and Embase, as well as a manual search of articles that were deemed relevant. Relevant articles were identified by using keywords such as “cardiogenic shock”.

Results

Literature was assessed to review the use of inotropes and vasopressors in CS. Dopamine and adrenaline were associated with increased mortality and arrhythmias. Dobutamine was associated with an improvement in cardiac output, at the determinant of causing arrhythmias. Conversely, noradrenaline was associated with a lower likelihood of arrhythmias and most importantly decreased mortality in CS. Compared to other inotropes, levosimendan appears to have a better safety profile and is associated with decreased mortality in CS, particularly when combined with a vasopressor.

Summary

Our literature review suggests that treatment combination of the inotrope levosimendan with the vasopressor noradrenaline may be the most effective management option in CS.

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Authors and Affiliations

  1. John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Surrey, UK

    Amanda Shabana

  2. Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Berkshire, UK

    Farzan Dholoo

  3. University Hospital Coventry and Warwickshire, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK

    Prithwish Banerjee

  4. Department of Cardiology, University Hospitals Coventry & Warwickshire, Clifford Bridge Road, Coventry, UK

    Prithwish Banerjee

  5. Warwick Medical School, University of Warwick, Coventry, UK

    Prithwish Banerjee

  6. Department of Health & Life Sciences, Coventry University, Coventry, UK

    Prithwish Banerjee

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  1. Amanda Shabana
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  2. Farzan Dholoo
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Amanda Shabana and Farzan Dholoo are primary/first authors responsible for conceptualisation, data curation, formal analysis, investigation, methodology, validation; visualisation, writing the report, performing the literature search, referencing the manuscript and submission of the manuscript. Prithwish Banerjee is the responsible consultant who oversaw the project, edited the manuscript up to submission and oversaw care of the submission.

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Correspondence to Amanda Shabana.

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Shabana, A., Dholoo, F. & Banerjee, P. Inotropic Agents and Vasopressors in the Treatment of Cardiogenic Shock. Curr Heart Fail Rep 17, 438–448 (2020). https://doi.org/10.1007/s11897-020-00493-9

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