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COMPARATIVE STUDY
JOURNAL ARTICLE
MULTICENTER STUDY
RANDOMIZED CONTROLLED TRIAL

Comparison of dopamine and norepinephrine in the treatment of shock

Daniel De Backer, Patrick Biston, Jacques Devriendt, Christian Madl, Didier Chochrad, Cesar Aldecoa, Alexandre Brasseur, Pierre Defrance, Philippe Gottignies, Jean-Louis Vincent
New England Journal of Medicine 2010 March 4, 362 (9): 779-89
20200382

BACKGROUND: Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.

METHODS: In this multicenter, randomized trial, we assigned patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. When blood pressure could not be maintained with a dose of 20 microg per kilogram of body weight per minute for dopamine or a dose of 0.19 microg per kilogram per minute for norepinephrine, open-label norepinephrine, epinephrine, or vasopressin could be added. The primary outcome was the rate of death at 28 days after randomization; secondary end points included the number of days without need for organ support and the occurrence of adverse events.

RESULTS: The trial included 1679 patients, of whom 858 were assigned to dopamine and 821 to norepinephrine. The baseline characteristics of the groups were similar. There was no significant between-group difference in the rate of death at 28 days (52.5% in the dopamine group and 48.5% in the norepinephrine group; odds ratio with dopamine, 1.17; 95% confidence interval, 0.97 to 1.42; P=0.10). However, there were more arrhythmic events among the patients treated with dopamine than among those treated with norepinephrine (207 events [24.1%] vs. 102 events [12.4%], P<0.001). A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock (P=0.03 for cardiogenic shock, P=0.19 for septic shock, and P=0.84 for hypovolemic shock, in Kaplan-Meier analyses).

CONCLUSIONS: Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treated with norepinephrine, the use of dopamine was associated with a greater number of adverse events. (ClinicalTrials.gov number, NCT00314704.)

Comments

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bhuvanesh mahendran wrote:

43

Amazing paper... Must read for every resident.

tiago gil wrote:

12

What should we do, follow American heart in use of dopamine or this excellent review and use norepinephrine ?

Adam Bialas wrote:

9

Excellent paper. Very important and interesting.

Dr Bijay Sah wrote:

7

Excellent paper. What inotropic agent is preferred in shock with severe PAH ?

sanzo rio wrote:

6

Thanks, excellent paper

Shoaib Saadat wrote:

5

Since conclusive evidence regarding epinephrine being superior is still not found in the primary end point, taking a hardcore line in favor of epinephrine will be biased. Amazing paper nevertheless

Dr. Tony Tran wrote:

4

Great read - a must for medical students.

michael brennan wrote:

3

Thank you

Ying Han wrote:

2

renal dysfunction and non-cardiogenic shock ----dopamine is preferable.
Cardiogenic shock ----norepinephrine

Chandresh Ghevariya wrote:

1

Norepineprine is best choice...for any shock

Victor Camacho wrote:

1

Interesting

Abdullah Mahnashi wrote:

1

Excellent paper

Roberto Valenzuela wrote:

1

Excellent paper.

AbdulRahman Masmaly wrote:

0

Excellent paper well done.

upinder dial wrote:

0

But it doesn't mention about noradrenaline associated takotsubo cardiomyopathy....as I know there is a correlation! It will be interesting to find out how deep is that connection in shocked patient treated with noradrenaline! Nevertheless this article is very useful!

Vladimir Manchurov wrote:

0

Norepinephrine is the first choice in pts with CS

Mohit Sahni wrote:

0

Well most patients with cardiac failure can be divided into groups based on arrhythmias and renal output....
norepinephrine is preferable when renal function is adequate and arrhythmias are not a problem...
But if renal function is inadequate dopamine will help with that too along with the hypotension.....

Regards....

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