Bruno Levy1,2,3, Thomas Klein1,2,3, Antoine Kimmoun1,2,3. 1. Service de Réanimation Médicale Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical. 2. INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy. 3. Université de Lorraine, Nancy, France.
Abstract
PURPOSE OF REVIEW: Data and interventional trials on vasopressor use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In the present article, we review the current use of vasopressor therapy during cardiogenic shock. RECENT FINDINGS: Two recent Cochrane analyses concluded that there was insufficient evidence to prove that any one vasopressor was superior to others in terms of mortality. A recent RCT and a meta-analysis on individual data suggested that norepinephrine may be preferred over epinephrine in patients with cardiogenic shock, in particular, after myocardial infarction. In patients with right ventricular failure and pulmonary hypertension, the use of vasopressin may be advocated under advanced monitoring. SUMMARY: When blood pressure needs to be restored, norepinephrine is a reasonable first-line agent. Information regarding comparative effective outcomes is sparse and their use should be limited to a temporary measure as a bridge to recovery, mechanical circulatory support or heart transplantation.
PURPOSE OF REVIEW: Data and interventional trials on vasopressor use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In the present article, we review the current use of vasopressor therapy during cardiogenic shock. RECENT FINDINGS: Two recent Cochrane analyses concluded that there was insufficient evidence to prove that any one vasopressor was superior to others in terms of mortality. A recent RCT and a meta-analysis on individual data suggested that norepinephrine may be preferred over epinephrine in patients with cardiogenic shock, in particular, after myocardial infarction. In patients with right ventricular failure and pulmonary hypertension, the use of vasopressin may be advocated under advanced monitoring. SUMMARY: When blood pressure needs to be restored, norepinephrine is a reasonable first-line agent. Information regarding comparative effective outcomes is sparse and their use should be limited to a temporary measure as a bridge to recovery, mechanical circulatory support or heart transplantation.
Authors: Mathieu Jozwiak; Guillaume Geri; Driss Laghlam; Kevin Boussion; Charles Dolladille; Lee S Nguyen Journal: Front Med (Lausanne) Date: 2022-05-23
Authors: Mahmoud A Ammar; Abdalla A Ammar; Patrick M Wieruszewski; Brittany D Bissell; Micah T Long; Lauren Albert; Ashish K Khanna; Gretchen L Sacha Journal: Ann Intensive Care Date: 2022-05-30 Impact factor: 10.318
Authors: Ary Serpa Neto; Giovanni Landoni; Marlies Ostermann; Nuttha Lumlertgul; Lui Forni; Lucas Alvarez-Belon; Tony Trapani; Patricia V Alliegro; Kai Zacharowski; Carolin Wiedenbeck; Daniel de Backer; Rinaldo Bellomo Journal: J Med Virol Date: 2022-01-21 Impact factor: 20.693
Authors: Halvor Langeland; Daniel Bergum; Magnus Løberg; Knut Bjørnstad; Thomas R Skaug; Trond Nordseth; Pål Klepstad; Nils Kristian Skjærvold Journal: Open Heart Date: 2022-01