Inappropriateness of “Inotropic” Support with Epinephrine

Abstract

As director of the Coronary Care Units in our Hospitals, it is my wont to attend patients with cardiac problems in the Intensive Care Units (ICU). It is with some sadness that I still find epinephrine commonly infused into patients requiring so called “inotropic support”. Upon enquiry into the true reason for giving this therapy, I often find that the answer boils down to treatment of low blood pressure. There is often no evidence presented that the inotropic state of the heart is compromised; indeed these patients may sometimes have no cardiac disease, or no evidence for an acute cardiac depression. It is also depressing to find that such patients frequently have central venous lines or even pulmonary artery (Swan-Ganz) catheters in place, but no attempt is made to measure cardiac output.