Cardiogenic Shock Clinical Trial
Official title:
Norepinephrine vs Norepinephrine and Dobutamine in Cardiogenic Shock : a Randomised, Opened, Cross-over Study. Heart SHOCK-NORDOB Study
Cardiogenic shock is a frequent cause of admission and death in the intensive care unit.
Mortality is about 50%. Once the etiologic treatment has been done, for instance coronary
revascularization, management of the shock state is the cornerstone of the treatment.
Norepinephrine is the first-line vasopressor therapy because of its minor effect on heart
rhythm. Morever norepinephrine is a inotrope. In a previous study, we demonstrated that
increasing the norepinephrine dose increases cardiac index, cardiac power index, SVO2 and
tissue perfusion without acceleration of heart rate. Nevertheless, dobutamine remains the
first-line inotropic treatment. Dobutamine has a positive chronotropic effect that might
cause higher myocardial oxygen consumption. As a result, combination of vasopressor /
inotrope is still controversial.
The aim of this study was to compare hemodynamics and metabolics effects of 2 treatments
strategies (norepinephrine dose increasing or addition of dobutamine) in patients with
cardiogenic shock and optimised blood pressure level (MAP≥65 mmHg) under norepinephrine
treatment.
The secondary objectives were :
- To evaluate the efficacy of the treatments on micro- and macrocirculation parameters
- To evaluate the tolerance of the treatments
- To evaluate the dose and the admistration's kinetics of the treatments
n/a
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