Cardiogenic Shock Clinical Trial
Official title:
Optimizing the Use of Vasopressor After Coronary Reperfusion in Cardiogenic Shock Secondary to Myocardial Infarction. Pathophysiological Study Comparing the Efficacy and Cardio-circulatory Tolerability of Epinephrine and Norepinephrine
The efficacy and tolerability of norepinephrine and epinephrine in cardiogenic shock after reperfused myocardial infarction will be compared, by following cardiac index evolution as main criteria. The study is a pilot pathophysiological study, randomized, double blind and multicenter.
Cardiogenic shock secondary to myocardial infarction is a frequent pathology in reanimation
and is associated with high mortality (50%). Hemodynamic management and notably the choice of
vasopressor in cardiogenic shock states secondary to myocardial infarction (cardiac index <
2.2 l/min/m-2) is not codified. There are two opposite views: a) the first is based on the
fact that an hypotensive patient with low cardiac output is primarily in need of an inotropic
agent and that, consequently, epinephrine is the molecule of choice (inotropic and
vasoconstrictor); b) the second is based on the fact that hypotension also reflects a certain
degree of vascular failure and vascular vasoplegia and therefore norepinephrine is the
molecule of choice along with, if needed, the eventual addition of dobutamine in order to
separately titrate vasoconstriction and inotropism.
Study hypotheses: epinephrine could facilitate myocardial function by providing the latter
with its preferred substrate (lactate) and thus induce a higher cardiac index along with
increased energy expenditure. Norepinephrine is the therapy of choice of hypotensive states;
nevertheless its lack of inotropic effect could theoretically exacerbate myocardial failure.
Thus, the aim of the study is to compared the efficiency and the tolerability of
norepinephrine and epinephrine in cardiogenic shock after reperfused myocardial infarction.
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