Hemodynamic and Clinical Outcomes of Milrinone Compared to Dobutamine in Cardiogenic Shock: A-Systematic Review and Meta-Analysis

  • William Bahagia Bhayangkara Palangkaraya Hospital
Keywords: Cardiogenic Shock, Dobutamine, Milrinone

Abstract

Background

Despite years of clinical experience with the two most commonly used inotropes i.e dobutamine and milrinone, in the cardiogenic shock setting, there is a lack of head-to-head comparison between inotropes in cardiogenic shock. We conducted a systematic review and meta-analysis on the comparison of hemodynamic and clinical effects of dobutamine and milrinone in cardiogenic shock.

Methods

A comprehensive literature search using PubMed and Scopus was performed. Among 40 studies retrieved from the database, 3 studies were included for hemodynamic comparison outcome and 2 studies for clinical outcomes.

Results

Three studies with 101 patients were included for hemodynamic analysis and two studies with 146 patients for clinical analysis. We observed no significant difference between cardiac index, pulmonary capillary wedge pressure, and mean arterial pressure at 1 hour after milrinone and dobutamine administration. However, there is significantly lower mPAP after milrinone infusion compared to dobutamine (mean difference -8,7 (-9,97 to -7,43) mmHg, p<0,01). We also observed no significant difference in in-hospital mortality but significantly shorter ICU length of stay in the milrinone group (mean difference -1 (-1,92 to -0,08) days).

Conclusion

Administration of milrinone resulted in lower PA pressure and shorter ICU LOS compared to dobutamine in patients with cardiogenic shock.

Downloads

Download data is not yet available.

References

1. Rab T, Ratanapo S, Kern KB, Basir MB, McDaniel M, Meraj P, et al. Cardiac Shock Care Centers: JACC Review Topic of the Week. Vol. 72, Journal of the American College of Cardiology. Elsevier USA; 2018. p. 1972–80.
2. Maeda K, Takanashi S, Saiki Y. Perioperative use of the intra-aortic balloon pump: Where do we stand in 2018? Vol. 33, Current Opinion in Cardiology. Lippincott Williams and Wilkins; 2018. p. 613–21.
3. Kalmanovich E, Audurier Y, Akodad M, Mourad M, Battistella P, Agullo A, et al. Management of advanced heart failure: a review. Vol. 16, Expert Review of Cardiovascular Therapy. Taylor and Francis Ltd; 2018. p. 775–94.
4. Mathew R, Santos GM, Visintini SM, Daniel F, Ramirez F, Disanto P, et al. Efficacy of milrinone and dobutamine in low cardiac output states: Systematic review and meta-analysis. Vol. 42, Clin Invest Med •. 2019.
5. Burger AJ, Horton DP, LeJemtel T, Ghali JK, Torre G, Dennish G, et al. Effect of nesiritide (B-type natriuretic peptide) and dobutamine on ventricular arrhythmias in the treatment of patients with acutely decompensated congestive heart failure: The precedent study. American Heart Journal. 2002 Dec 1;144(6):1102–8.
6. Mathew R, di Santo P, Jung RG, Marbach JA, Hutson J, Simard T, et al. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. New England Journal of Medicine. 2021 Aug 5;385(6):516–25.
7. Hollenberg SM, Kavinsky CJ, Parrillo JE. Cardiogenic Shock. 1999.
8. Jentzer JC, Coons JC, Link CB, Schmidhofer M. Pharmacotherapy Update on the Use of Vasopressors and Inotropes in the Intensive Care Unit. Vol. 20, Journal of Cardiovascular Pharmacology and Therapeutics. SAGE Publications Ltd; 2015. p. 249–60.
9. Zimmerman J, Lee JP, Cahalan M. Vasopressors and inotropes. In: Pharmacology and Physiology for Anesthesia: Foundations and Clinical Application. Elsevier; 2018. p. 520–34.
10. Ayres JK, Maani CV. Milrinone [Internet]. Vol. 1. 2021 [cited 2022 Feb 16]. 2–3 p. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532943/
Published
2022-09-30
Views & Downloads
Abstract views: 864   
Full Text (PDF) downloads: 688   
How to Cite
Bahagia, W. (2022). Hemodynamic and Clinical Outcomes of Milrinone Compared to Dobutamine in Cardiogenic Shock: A-Systematic Review and Meta-Analysis. Indonesian Journal of Cardiology, 43(3), 108-15. https://doi.org/10.30701/ijc.1296