Cardiology in critical care · Choice of vasopressor in shock
Comparison of dopamine and norepinephrine in the treatment of shock
| Design | Multicentre, blinded randomised controlled trial |
|---|---|
| Treatment | Dopamine as first-line vasopressor |
| Control | Noradrenaline as first-line vasopressor |
| Population | 1679 patients with shock of any cause |
| Follow-up | 12 months |
| Primary endpoint | 28-day all-cause mortality |
| Result | 858 patients received dopamine and 821 noradrenaline. There was no significant between-group difference in the rate of death at 28 days, but dopamine was associated with substantially more arrhythmic events, and with higher mortality in the prespecified cardiogenic shock subgroup. |
| Secondary endpoints | Arrhythmic events, mortality by shock subtype, organ dysfunction |
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.
The trial authors, in the published abstract
Ended dopamine as a first-line vasopressor. The headline is neutral and the practice change came from the safety data and the cardiogenic shock subgroup — a case where secondary findings rightly outweighed a null primary result.
De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010 Mar 4;362(9):779-89.