Is this the end of Dopamine?

Todd Fraser on 07-03-2010

The March 4 edition of the New England Journal of Medicine features a study comparing Dopamine and Noradrenaline in the treatment of 1600 patients with shock. Patients with cardiogenic, septic and hypovolaemic shock were included. It comes as little surprise to many that there was little difference in mortality found in all comers in the intention to treat analysis, and a probable increase in mortality in the subgroup of cardiogenic shock. Additionally, dopamine had higher complication rates, particularly due to arrhythmias. Dopamine's place in the world has bee questioned for some time, and found voice after the publication of ANZICS-CTG's very first paper studying its role as a renal protective agent in 2000. Subsequent studies have also questioned its role. Nonetheless, it still remains embedded in several international guidelines, including the surviving sepsis campaign. So is the last we'll see of dopamine? What inotropes / vasoconstrictors do you use, in what circumstance and how do you titrate them?


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Todd Fraser wrote 04-26-2011 02:44:56 pm
The answer to my title question is "Clearly Not", as we see the release of yet another metanalysis comparing it to Noradrenaline in sepsis (check it out in journal club).

This newest study demonstrated what we've all known for some time, that noradrenaline is superior to dopamine, and that dopamine causes more arrhythmias.

Strangely, the group with 'septic shock' did not show a difference, as distinct from the entire group who had 'shock, predominantly due to sepsis'. The significance of this is unclear.




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