POSTCARDIAC SURGERY LOW CARDIAC-OUTPUT SYNDROME - DOPEXAMINE OR DOPAMINE

Objective: To compare the efficacy and safety of dopexamine with dopam ine in the treatment of low cardiac output syndrome after cardiac surg ery. Design: This was a multicentre, double-blind, randomised, paralle l-group study conducted in intensive care units at centres in Holland and Belgium. Patients were randomised to receive dopexamine (up to 2.0 mu g/kg per min) or dopamine (up to 6.0 mu g/kg per min) for 6 h afte r low cardiac output syndrome was confirmed, Results: 70 patients were enrolled (35/group) and there was no significant difference in the op erative procedures or haemodynamics at entry into the study Clinical e fficacy, defined as a cardiac index > 2.5 l/min per m(2) with urine pr oduction > 0.5 ml/kg per h and stable haemodynamics for two consecutiv e readings 1 h apart, was achieved by 90 and 57 % of patients in the d opexamine and dopamine groups, respectively. However, more patients ma intained clinical efficacy over the 6-h period in the dopexamine group , which was statistically significant at 1-2 h and approached signific ance at all other time points. Safety was assessed by comparing the ad verse events and concomitant medication. Fewer patients on dopexamine had cardiac events compared with dopamine-treated patients (25 vs 38 e vents), although there was no differencee in the pattern of rhythm dis turbance. Fewer patients in the dopexamine group required concomitant vasodilating drugs (18 vs 30). Conclusion: Taking the proportion of pa tients achieving clinical efficacy, the time to achieve it and the mai ntenance of it along with the adverse event profile, dopexamine was sh own to be an effective and safe drug to use in the management of low c ardiac output syndrome after coronary artery bypass graft surgery and may be superior to dopamine.