Dr. Benjamin Hibbert MD. University of Ottawa Heart Institute - Speaks on Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock

Link to Abstract:
https://www.nejm.org/doi/full/10.1056/NEJMoa2026845?query=cardiology


CONTEXT: Cardiogenic shock is linked to a high rate of morbidity and mortality. Although inotropic support is a common part of medical treatment for cardiogenic shock, there is no data to guide inotropic drug selection in clinical practice.

METHODS: In a double-blind study, individuals with cardiogenic shock were randomly randomized to receive milrinone or dobutamine. In-hospital death from any cause, resuscitated cardiac arrest, cardiac transplantation or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke identified by a neurologist, or beginning of renal replacement therapy were the major outcomes. Individual components of the primary composite result were included as secondary outcomes.

RESULTS: A total of 192 people were enrolled (96 in each group). The primary result did not differ substantially between the treatment groups; 47 participants (49%) in the milrinone group and 52 participants (54%) in the dobutamine group (relative risk, 0.90; 95 percent confidence interval [CI], 0.69 to 1.19; P=0.47) experienced a primary outcome event. Secondary outcomes such as in-hospital death (37 percent and 43 percent of participants, respectively; relative risk, 0.85; 95 percent CI, 0.60 to 1.21), resuscitated cardiac arrest (7 percent and 9 percent; hazard ratio, 0.78; 95 percent CI, 0.29 to 2.07), and mechanical circulatory support (12 percent) showed no significant differences between the groups (22 percent and 17 percent ; hazard ratio, 1.39; 95 percent CI, 0.73 to 2.67).

CONCLUSIONS: There was no significant difference between milrinone and dobutamine in individuals with cardiogenic shock in terms of the key composite outcome or crucial secondary outcomes. (Funded by the Ontario Academic Health Sciences Centres Alternative Funding Plan's Innovation Fund; ClinicalTrials.gov number: NCT03207165. opens in new tab.)