Comparison of dopamine and norepinephrine in the treatment of shock
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.)
Responses
bhuvanesh mahendran
Amazing paper... Must read for every resident.
Posted 24 Apr, 2013 at 8:32Dr. Bijay Sah
Excellent paper. What inotropic agent is preferred in shock with severe PAH ?
Posted 31 Oct, 2016 at 16:45tiago gil
What should we do, follow American heart in use of dopamine or this excellent review and use norepinephrine ?
Posted 16 Aug, 2013 at 12:39Adam Bialas
Excellent paper. Very important and interesting.
Posted 29 Jul, 2013 at 20:14Ying Han
renal dysfunction and non-cardiogenic shock ----dopamine is preferable.
Posted 8 May, 2015 at 4:08Cardiogenic shock ----norepinephrine
Shoaib Saadat
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
Posted 14 Oct, 2014 at 8:06sanzo rio
Thanks, excellent paper
Posted 29 Jun, 2013 at 9:52Dr. Tony Tran
Great read - a must for medical students.
Posted 13 Mar, 2014 at 0:10michael brennan
Thank you
Posted 1 Oct, 2013 at 13:50Chandresh Ghevariya
Norepineprine is best choice...for any shock
Posted 12 Jun, 2015 at 6:15AbdulRahman Masmaly
Excellent paper well done.
Posted 1 Jun, 2017 at 2:31Victor Camacho
Interesting
Posted 19 Sep, 2014 at 14:35Abdullah Mahnashi
Excellent paper
Posted 29 Jun, 2014 at 20:30Sserunkuuma Bruno
Nice paper
Posted 9 Dec, 2019 at 20:34upinder dial
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!
Posted 26 Nov, 2016 at 10:56Roberto Valenzuela
Excellent paper.
Posted 31 Jan, 2014 at 5:02Tao Liu
nice paper
Posted 8 Sep, 2020 at 13:25Alejandro Pedraza
always NE!
Posted 26 Mar, 2019 at 1:55JeJe Awag
Interesting!
Posted 11 Oct, 2018 at 19:33Mohit Sahni
Well most patients with cardiac failure can be divided into groups based on arrhythmias and renal output....
Posted 5 Oct, 2014 at 23:54norepinephrine 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....
Vladimir Manchurov
Norepinephrine is the first choice in pts with CS
Posted 21 Nov, 2015 at 13:11