ATLANTA - Physicians treating patients with shock should consider norepinephrine instead of dopamine as a tool for stabilizing blood pressure, according to an editorial in the March 4, 2010, issue of the New England Journal of Medicine (NEJM).
Jerrold Levy, MD, FAHA, professor and deputy chair for research, Department of Anesthesiology, Emory University School of Medicine, and co-director of cardiothoracic anesthesiology, Emory Healthcare, authored the editorial.
The editorial accompanies a report in the same issue of NEJM on a European clinical trial evaluating dopamine and norepinephrine in shock patients. The randomized trial, led by Daniel De Backer, MD, PhD, at Erasme University Hospital in Belgium, compared 28-day mortality in 1679 patients treated for shock with dopamine or norepinephrine in Austria, Belgium and Spain between 2003 and 2007.
"Dopamine has been commonly used as a first-line therapy for shock at many hospitals for years, partially because of the widespread perception that norepinephrine is associated with adverse events," Levy says. "The current study supports the concept that shock from any cause carries a high risk of death, and raises significant concerns about the safety of dopamine."
Shock, or dangerously low blood pressure, can occur as a result of sepsis (severe inflammation resulting from bacterial infection), heart failure (cardiogenic), hemorrhage (severe blood loss) or anaphylaxis. Most of the patients (62.2 percent) in the European trial had septic shock, 16.7 percent had heart failure and 15.7 percent hemorrhage.
The authors of the clinical study reported no overall difference in death rates at 28 days. However, heart arrhythmias were almost twice as common in the dopamine group (24.1 percent vs 12.4 percent) and mortality was higher for patients with cardiogenic shock treated with dopamine.
A previous observational study showed that dopamine's use in intensive care
|Contact: Lance Skelly|