Are vasopressors useful in toxin-induced cardiogenic shock?

OBJECTIVE: Overdoses with cardio-depressive medications can result in toxin-induced cardiogenic shock (TICS), a life-threatening condition characterized by severe hypotension and ineffective tissue perfusion. Vasopressors are often employed in the treatment of shock to increase heart rate and blood pressure. We sought to conduct a systematic review of the literature to evaluate the effectiveness of vasopressors in improving hemodynamic function and survival in the treatment of TICS.

DATA SOURCES: We searched PubMed, EMBASE, TOXLINE, and International Pharmaceutical Abstracts.

STUDY SELECTION: We included studies evaluating the use of vasopressors in humans or animals with TICS. We limited human study types to randomized controlled trials, clinical trials, observational studies, and case reports.

DATA EXTRACTION: Our search yielded 913 citations and 144 of these met our inclusion criteria. 130 were human case reports and 14 were animal studies.

DATA SYNTHESIS: Human case report data showed vasopressors were ineffective more often than they were partially or fully effective. In the majority of animal studies, vasopressor treatment failed to improve hemodynamic parameters and resulted in decreased survival.

CONCLUSIONS: Human case reports and controlled animal experiments lead to different conclusions about vasopressors in TICS. Most animal studies indicate that vasopressors impair hemodynamic function and increase mortality. In contrast, human case reports suggest that vasopressors are often ineffective but not necessarily harmful.