A. Meissner et al., COMBINED HEMODYNAMIC-EFFECTS OF DOPAMINE MILRINONE AS COMPARED TO DOPAMINE/DOBUTAMINE IN CARDIOGENIC-SHOCK/, Zeitschrift fur Kardiologie, 85(11), 1996, pp. 839-846
In cardiogenic shock, combined pharmacotherapy with dopamine/dobutamin
e was being used as a standard regimen and was compared to dopamine/mi
lrinone in this study. In a total of 20 patients with persistent hemod
ynamic depression despite mechanical ventilation plus dopamine (10-12
mu g/kg/min) and nitroglycerin (33 mu g/min) infusions additional ther
apy with dobutamine (maximal dose: 9 mu g/kg/min; n = 10) or milrinone
(0.5 mu g/kg/min; n = 10) was started. Dobutamine induced an increase
of cardiac index (2.0 +/- 0.1 to 2.9 +/- 0.2 l/min/m(2); p < 0.01; me
an +/- SEM) and heart rate (96 +/- 6 to 117 +/- 5 min(-1); p < 0.05) w
hile mean arterial pressure (75 +/- 2 to 71 +/- 4 mm Hg) and pulmonary
capillary wedge pressure (21 +/- 2 to 19 +/- 2 mm Hg) hardly changed.
The rate-pressure product rose from 10 790 +/- 684 to 13 234 +/- 678
mm Hg/min (p < 0.05). Milrinone had a comparable effect on cardiac ind
ex (2.0 +/- 0.1 to 2.6 +/- 0.1 l/min/m(2); p < 0.01) but induced a min
or change in heart rate (94 +/- 6 to 104 +/- 8 min(-1); p < 0.05) and
a more pronounced decrease in mean arterial pressure (77 +/- 2 to 65 /- 2 mm Hg; p < 0.01) and pulmonary capillary wedge pressure (24 +/- 2
to 17 +/- 1 mm Hg; p < 0.01). The rate-pressure product declined (11
033 +/- 711 to 10 555 +/- 929 mm Hg/min). In comparison, dopamine/milr
inone appeared to be advantageous in terms of pre- and afterload reduc
tion and myocardial oxygen demand. However, the concomitant decline in
arterial pressure might impair end-organ perfusion.