Cardiology in critical care · Inotrope choice in cardiogenic shock
Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock
| Design | Pragmatic, double-blind randomised controlled trial |
|---|---|
| Treatment | Milrinone |
| Control | Dobutamine |
| Population | 192 participants with cardiogenic shock, 96 in each group |
| Follow-up | Hospital discharge |
| Primary endpoint | Composite of in-hospital death, resuscitated cardiac arrest, cardiac transplant or mechanical circulatory support, non-fatal myocardial infarction, transient ischaemic attack or stroke, or initiation of renal replacement therapy |
| Result | A primary outcome event occurred in 47 participants (49%) in the milrinone group, with no significant difference from dobutamine. |
| Secondary endpoints | Individual components of the composite, length of stay, arrhythmia |
In patients with cardiogenic shock, no significant difference between milrinone and dobutamine was found with respect to the primary composite outcome or important secondary outcomes.
The trial authors, in the published abstract
A long-argued preference resolved as a tie. Choose on pharmacokinetics, renal function and cost rather than on evidence of superiority — the same conclusion the sedation trials reached for their agents.
Mathew R, Di Santo P, Jung RG, et al. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med 2021 Aug 5;385(6):516-525.