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Cochrane Library Cochrane Library Cochrane Database of Systematic Reviews Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome (Review) Uhlig K, Efremov L, Tongers J, Frantz S, Mikolajczyk R, Sedding D, Schumann J Uhlig K, Efremov L, Tongers J, Frantz S, Mikolajczyk R, Sedding D, Schumann J. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD009669. DOI: 10.1002/14651858.CD009669.pub4. www.cochranelibrary.com Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome (Review) Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Cochrane Trusted evidence. Informed decisions. Library Better health. Cochrane Database of Systematic Reviews T A B L E O F C O N T E N T S HEADER......................................................................................................................................................................................................... 1 ABSTRACT..................................................................................................................................................................................................... 1 PLAIN LANGUAGE SUMMARY....................................................................................................................................................................... 2 SUMMARY OF FINDINGS.............................................................................................................................................................................. 4 BACKGROUND.............................................................................................................................................................................................. 15 OBJECTIVES.................................................................................................................................................................................................. 16 METHODS..................................................................................................................................................................................................... 16 Figure 1.................................................................................................................................................................................................. 18 RESULTS........................................................................................................................................................................................................ 20 Figure 2.................................................................................................................................................................................................. 24 Figure 3.................................................................................................................................................................................................. 25 DISCUSSION.................................................................................................................................................................................................. 31 AUTHORS' CONCLUSIONS........................................................................................................................................................................... 34 ACKNOWLEDGEMENTS................................................................................................................................................................................ 35 REFERENCES................................................................................................................................................................................................ 36 CHARACTERISTICS OF STUDIES.................................................................................................................................................................. 41 DATA AND ANALYSES.................................................................................................................................................................................... 88 Analysis 1.1. Comparison 1: Levosimendan versus dobutamine, Outcome 1: All-cause short-term mortality............................... 89 Analysis 1.2. Comparison 1: Levosimendan versus dobutamine, Outcome 2: All-cause short-term mortality: sensitivity 89 analysis.................................................................................................................................................................................................. Analysis 1.3. Comparison 1: Levosimendan versus dobutamine, Outcome 3: All-cause long-term mortality................................. 89 Analysis 1.4. Comparison 1: Levosimendan versus dobutamine, Outcome 4: All-cause long-term mortality: sensitivity analysis... 90 Analysis 1.5. Comparison 1: Levosimendan versus dobutamine, Outcome 5: MACE (Perioperative infarction).............................. 90 Analysis 1.6. Comparison 1: Levosimendan versus dobutamine, Outcome 6: MACE (Cerebrovascular accidents)......................... 90 Analysis 1.7. Comparison 1: Levosimendan versus dobutamine, Outcome 7: Haemodynamics (Cardiac index)........................... 90 Analysis 1.8. Comparison 1: Levosimendan versus dobutamine, Outcome 8: Haemodynamics (Pulmonary capillary wedge 91 pressure)................................................................................................................................................................................................ Analysis 1.9. Comparison 1: Levosimendan versus dobutamine, Outcome 9: Haemodynamics (Mean arterial pressure)............. 91 Analysis 2.1. Comparison 2: Levosimendan versus placebo, Outcome 1: All-cause long-term mortality........................................ 92 Analysis 2.2. Comparison 2: Levosimendan versus placebo, Outcome 2: All-cause long-term mortality: sensitivity analysis........ 92 Analysis 2.3. Comparison 2: Levosimendan versus placebo, Outcome 3: Haemodynamics (Cardiac index)................................... 92 Analysis 2.4. Comparison 2: Levosimendan versus placebo, Outcome 4: Haemodynamics (Pulmonary capillary wedge 92 pressure)................................................................................................................................................................................................ Analysis 2.5. Comparison 2: Levosimendan versus placebo, Outcome 5: Haemodynamics (Mean arterial pressure).................... 93 Analysis 3.1. Comparison 3: Levosimendan versus enoximone, Outcome 1: All-cause short-term mortality................................. 93 Analysis 3.2. Comparison 3: Levosimendan versus enoximone, Outcome 2: All-cause short-term mortality: sensitivity analysis.... 93 Analysis 3.3. Comparison 3: Levosimendan versus enoximone, Outcome 3: MACE (Cerebrovascular accidents)........................... 94 Analysis 4.1. Comparison 4: Epinephrine versus norepinephrine-dobutamine, Outcome 1: All-cause short-term mortality......... 94 Analysis 4.2. Comparison 4: Epinephrine versus norepinephrine-dobutamine, Outcome 2: All-cause short-term mortality: 94 sensitivity analysis................................................................................................................................................................................ Analysis 4.3. Comparison 4: Epinephrine versus norepinephrine-dobutamine, Outcome 3: Haemodynamics (Cardiac index)...... 95 Analysis 4.4. Comparison 4: Epinephrine versus norepinephrine-dobutamine, Outcome 4: Haemodynamics (Pulmonary 95 capillary wedge pressure).................................................................................................................................................................... Analysis 4.5. Comparison 4: Epinephrine versus norepinephrine-dobutamine, Outcome 5: Haemodynamics (Mean arterial 95 pressure)................................................................................................................................................................................................ Analysis 5.1. Comparison 5: Dopexamine versus dopamine, Outcome 1: MACE (Perioperative infarctions)................................... 96 Analysis 5.2. Comparison 5: Dopexamine versus dopamine, Outcome 2: Haemodynamics (Cardiac index).................................. 96 Analysis 5.3. Comparison 5: Dopexamine versus dopamine, Outcome 3: Hemodynamics (Pulmonary capillary wedge 96 pressure)................................................................................................................................................................................................ Analysis 5.4. Comparison 5: Dopexamine versus dopamine, Outcome 4: Haemodynamics (Mean arterial pressure).................... 96 Analysis 6.1. Comparison 6: Milrinone versus dobutamine, Outcome 1: Haemodynamics (Cardiac index).................................... 97 Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome (Review) i Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Cochrane Trusted evidence. Informed decisions. Library Better health. Cochrane Database of Systematic Reviews Analysis 6.2. Comparison 6: Milrinone
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