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


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.


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.

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Fig. 1


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

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Correspondence to Dieter Van Beersel.

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

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

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Van Beersel, D., Rex, S. Inotropes and Vasoactive Agents: Differences Between Europe and the United States. Curr Anesthesiol Rep 9, 202–213 (2019).

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  • Circulatory shock
  • Vasoactive agents
  • Inotropes
  • Europe
  • United States
  • Guidelines
  • Septic shock
  • Acute heart failure
  • Cardiac surgery
  • Low cardiac output
  • Variation