Health  Vol.6 No.18 , October 2014
Dobutamine Infusion and Absence of Pulmonary Hypertension Are Associated with Decreased Mortality in a Cohort of 249 Patients with Cardiogenic Shock
ABSTRACT
Objective: Prognostic analysis of 249 patients admitted for cardiogenic shock (CS) of various origins. Background: Little is known about prognosis of CS from non-ischemic cardiomyopathy. Methods: Retrospective monocentric study of patients referred to an ICU during 2 years. Results: Despite aggressive management including intra-aortic balloon pump (31%), extra-renal replacement therapy (36%), extra-corporeal life support (8%), and catecholamine infusion (97%), in-hospital mortality was 46%. Toxic CS or CS related to deficiency carried a better outcome (mortality 5%). Post-myocardial infarction or post-cardiac arrest CS was associated with higher mortality. In the multivariate analyses, only SAPS II (OR 1.037; 1.013 - 1.056; p = 0.0001), pulmonary hypertension (OR 4.8; 1.3 - 17; p = 0.02), extra-renal replacement therapy (OR 2.9; 1.3 - 6; p = 0.006), and dobutamine infusion (OR 0.44; 0.2 - 0.96; p = 0.04) were significantly associated with in-hospital mortality. Conclusion: Dobutamine infusion was associated with a better outcome. Higher SAPS II, pulmonary hypertension, and extra-renal replacement therapy were associated with increased in-hospital mortality.

Cite this paper
Champion, S. , Gaüzère, B. , Vandroux, D. , Bouchet, B. , Drouet, D. and Lefort, Y. (2014) Dobutamine Infusion and Absence of Pulmonary Hypertension Are Associated with Decreased Mortality in a Cohort of 249 Patients with Cardiogenic Shock. Health, 6, 2408-2415. doi: 10.4236/health.2014.618277.
References
[1]   Thiele, H., Allam, B., Chatellier, G., Schuler, G. and Lafont, A. (2010) Shock in Acute Myocardial Infarction: The Cape Horn for trials? European Heart Journal, 31, 1828-1835.
http://dx.doi.org/10.1093/eurheartj/ehq220

[2]   McMurray, J.J., Adamopoulos, S., Anker, S.D., Auricchio, A., Bohm, M., Dickstein, K., Falk, V., Filippatos, G., Fonseca, C., Gomez-Sanchez, M.A., Jaarsma, T., Kober, L., Lip, G.Y., Maggioni, A.P., Parkhomenko, A., Pieske, B.M., Popescu, B.A., Ronnevik, P.K., Rutten, F.H., Schwitter, J., Seferovic, P., Stepinska, J., Trindade, P.T., Voors, A.A., Zannad, F., Zeiher, A., Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology, Bax, J.J., Baumgartner, H., Ceconi, C., Dean, V., Deaton, C., Fagard, R., Funck-Brentano, C., Hasdai, D., Hoes, A., Kirchhof, P., Knuuti, J., Kolh, P., McDonagh, T., Moulin, C., Popescu, B.A., Reiner, Z., Sechtem, U., Sirnes, P.A., Tendera, M., Torbicki, A., Vahanian, A., Windecker, S., McDonagh, T., Sechtem, U., Bonet, L.A., Avraamides, P., Ben Lamin, H.A., Brignole, M., Coca, A., Cowburn, P., Dargie, H., Elliott, P., Flachskampf, F.A., Guida, G.F., Hardman, S., Iung, B., Merkely, B., Mueller, C., Nanas, J.N., Nielsen, O.W., Orn, S., Parissis, J.T. and Ponikowski, P., ESC Committee for Practice Guidelines (2012) ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in Collaboration with the Heart Failure Association (HFA) of the ESC. European Journal of Heart Failure, 14, 803-869.
http://dx.doi.org/10.1093/eurjhf/hfs105

[3]   Bangash, M.N., Kong, M.L. and Pearse, R.M. (2012) Use of Inotropes and Vasopressor Agents in Critically Ill Patients. British Journal of Pharmacology, 165, 2015-2033.
http://dx.doi.org/10.1111/j.1476-5381.2011.01588.x

[4]   Overgaard, C.B. and Dzavík, V. (2008) Inotropes and Vasopressors: Review of Physiology and Clinical Use in Cardiovascular Disease. Circulation, 118, 1047-1056.
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.728840

[5]   Hollenberg, S.M. (2011) Vasoactive Drugs in Circulatory Shock. American Journal of Respiratory and Critical Care Medicine, 183, 847-855.
http://dx.doi.org/10.1164/rccm.201006-0972CI

[6]   De Backer, D., Biston, P., Devriendt, J., Madl, C., Chochrad, D., Aldecoa, C., Brasseur, A., Defrance, P., Gottignies, P., Vincent, J.L. and SOAP II Investigators (2010) Comparison of Dopamine and Norepinephrine in the Treatment of Shock. New England Journal of Medicine, 362, 779-789.
http://dx.doi.org/10.1056/NEJMoa0907118

[7]   Carpati, C.M., Astiz, M.E. and Rackow, E.C. (1997) Optimizing Gastric Mucosal Perfusion: All Catecholamines May Not Be Created Equal. Critical Care Medicine, 25, 1624-1625.
http://dx.doi.org/10.1097/00003246-199710000-00004

[8]   Levy, B., Perez, P., Perny, J., Thivilier, C. and Gerard, A. (2011) Comparison of Norepinephrine-Dobutamine to Epinephrine for Hemodynamics, Lactate Metabolism, and Organ Function Variables in Cardiogenic Shock. A Prospective, Randomized Pilot Study. Critical Care Medicine, 39, 450-455.
http://dx.doi.org/10.1097/CCM.0b013e3181ffe0eb

[9]   Annane, D., Vignon, P., Renault, A., Bollaert, P.E., Charpentier, C., Martin, C., Troché, G., Ricard, J.D., Nitenberg, G., Papazian, L., Azoulay, E. And Bellissant, E., CATS Study Group (2007) Norepinephrine plus Dobutamine versus Epinephrine Alone for Management of Septic Shock: A Randomised Trial. Lancet, 370, 676-684.
http://dx.doi.org/10.1016/S0140-6736(07)61344-0

[10]   Myburgh, J.A., Higgins, A., Jovanovska, A., Lipman, J., Ramakrishnan, N. and Santamaria, J., CAT Study Investigators (2008) A Comparison of Epinephrine and Norepinephrine in Critically Ill Patients. Intensive Care Medicine, 34, 2226-2234.
http://dx.doi.org/10.1007/s00134-008-1219-0

[11]   Georgiopoulou, V.V., Kalogeropoulos, A.P., Borlaug, B.A., Gheorghiade, M. and Butler, J. (2013) Left Ventricular Dysfunction with Pulmonary Hypertension: Part 1: Epidemiology, Pathophysiology, and Definitions. Circulation: Heart Failure, 6, 344-354.
http://dx.doi.org/10.1161/CIRCHEARTFAILURE.112.000095

[12]   Vellinga, N.A., Ince, C. and Boerma, E.C. (2013) Elevated Central Venous Pressure Is Associated with Impairment of Microcirculatory Blood Flow in Sepsis: A Hypothesis Generating Post Hoc Analysis. BMC Anesthesiology, 13, 17.
http://dx.doi.org/10.1186/1471-2253-13-17

[13]   Damman, K., van Deursen, V.M., Navis, G., Voors, A.A., van Veldhuisen, D.J. and Hillege, H.L. (2009) Increased Central Venous Pressure Is Associated with Impaired Renal Function and Mortality in a Broad Spectrum of Patients with Cardiovascular Disease. Journal of the American College of Cardiology, 53, 582-588.
http://dx.doi.org/10.1016/j.jacc.2008.08.080

[14]   Mebazaa, A., Karpati, P., Renaud, E. and Algotsson, L. (2004) Acute Right Ventricular Failure—From Pathophysiology to New Treatments. Intensive Care Medicine, 30, 185-196.
http://dx.doi.org/10.1007/s00134-003-2025-3

[15]   Lesage, A., Ramakers, M., Daubin, C., Verrier, V., Beynier, D., Charbonneau, P. and Cheyron, D. (2004) Complicated Acute Myocardial Infarction Requiring Mechanical Ventilation in the Intensive Care Unit: Prognostic Factors of Clinical Outcome in a Series of 157 Patients. Critical Care Medicine, 32, 100-105.
http://dx.doi.org/10.1097/01.CCM.0000098605.58349.76

[16]   Bart, B.A., Goldsmith, S.R., Lee, K.L., Givertz, M.M,. O’Connor, C.M., Bull, D.A., Redfield, M.M., Deswal, A., Rouleau, J.L., LeWinter, M.M., Ofili, E.O., Stevenson, L.W., Semigran, M.J., Felker, G.M., Chen, H.H., Hernandez, A.F., Anstrom, K.J., McNulty, S.E., Velazquez, E.J., Ibarra, J.C., Mascette, A.M. and Braunwald, E. (2012) Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome. The New England Journal of Medicine, 367, 2296-2304.
http://dx.doi.org/10.1056/nejmoa1210357

[17]   Pirracchio, R., Parenica, J., Rigon, M.R., Chevret, S., Spinar, J., Jarkovsky, J., Zannad, F., Alla, F. and Mebazaa, A. (2013) The Effectiveness of Inodilators in Reducing Short Term Mortality among Patient with Severe Cardiogenic Shock: A Propensity-Based Analysis. PLoS ONE, 8, e71659.
http://dx.doi.org/10.1371/journal.pone.0071659

[18]   Agrawal, R., Al-Khafaji, A. and Yende, S. (2010) Epinephrine: Is It Really the Black Sheep of Vasoactive Agents? Critical Care, 14, 309.
http://dx.doi.org/10.1186/cc8998

[19]   Lin, H. and Young, D.B. (1995) Opposing Effects of Plasma Epinephrine and Norepinephrine on Coronary Thrombosis in Vivo. Circulation, 91, 1135-1142.
http://dx.doi.org/10.1161/01.CIR.91.4.1135

[20]   Havel, C., Arrich, J., Losert, H., Gamper, G., Müllner, M. and Herkner, H. (2011) Vasopressors for Hypotensive Shock. Cochrane Database of Systematic Reviews, 5, Article ID: CD003709.

[21]   Galloway, M.T., Paglieroni, T.G., Wun, T., Arena, F.J. and Lewis, W.R. (1998) Platelet Activation during Dobutamine Stress Echocardiography. American Heart Journal, 135, 888-900.
http://dx.doi.org/10.1016/S0002-8703(98)70051-1

[22]   Bohm, M., Link, A., Cai, D., Nieminen, M.S., Filippatos, G.S., Salem, R., Cohen Solal A., Huang, B., Padley, R.J., Kivikko, M. and Mebazaa, A. (2011) Beneficial Association of β-Blocker Therapy on Recovery from Severe Acute Heart Failure Treatment: Data from the Survival of Patients with Acute Heart Failure in Need of Intravenous Inotropic Support Trial. Critical Care Medicine, 39, 940-944.
http://dx.doi.org/10.1097/CCM.0b013e31820a91ed

[23]   Champion, S. (2014) Statins for Patients with Cardiogenic Shock. Korean Circulation Journal, 44, 200-202.
http://dx.doi.org/10.4070/kcj.2014.44.3.200

[24]   Champion, S., Gaüzère, B.A. and Vandroux, D. (2012) Hypophosphatemia in Patients with Cardiogenic Shock. Journal of Critical Care, 27, 511.
http://dx.doi.org/10.1016/j.jcrc.2012.07.018

[25]   Champion, S., Gaüzère, B.A. and Lefort, Y. (2012) Drug-Eluting Stents Should Not Be Used in ST-Elevated Myocardial Infarction with Cardiogenic Shock. Archives of Internal Medicine, 172, 1613-1614.
http://dx.doi.org/10.1001/archinternmed.2012.4418

[26]   Forsythe, R.M., Wessel, C.B., Billiar, T.R., Angus, D.C. and Rosengart, M.R. (2008) Parenteral Calcium for Intensive Care Unit Patients. Cochrane Database of Systematic Reviews, 8, Article ID: CD006163.

[27]   Stegman, B.M., Newby, L.K., Hochman, J.S. and Ohman, E.M. (2012) Post-Myocardial Infarction Cardiogenic Shock Is a Systemic Illness in Need of Systemic Treatment: Is Therapeutic Hypothermia One Possibility? Journal of the American College of Cardiology, 59, 644-647.
http://dx.doi.org/10.1016/j.jacc.2011.11.010

[28]   Champion, S., Deye, N., Mégarbane, B. and Baud, F.J. (2013) Should All Out-of-Hospital Cardiac Arrest Patients Presenting with Cardiogenic Shock Be Treated with Therapeutic Hypothermia? Critical Care Medicine, 41, e6-e7.
http://dx.doi.org/10.1097/CCM.0b013e318270e28e

[29]   Thiele, H., Zeymer, U., Neumann, F.J., Ferenc, M., Olbrich, H.G., Hausleiter, J., Richardt, G., Hennersdorf, M., Empen, K., Fuernau, G., Desch, S., Eitel, I., Hambrecht, R., Fuhrmann, J., Bohm, M., Ebelt, H., Schneider, S., Schuler, G. and Werdan, K. (2012) Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock. The New England Journal of Medicine, 367, 1287-1296.
http://dx.doi.org/10.1056/nejmoa1208410

[30]   Maggio, P., Hemmila, M., Haft, J. and Bartlett, R. (2007) Extracorporeal Life Support for Massive Pulmonary Embolism. Journal of Trauma-Injury Infection & Critical Care, 62, 570-576.
http://dx.doi.org/10.1097/TA.0b013e318031cd0c

[31]   Krenn, L. and Karth, G.D. (2011) Essential Lessons in Cardiogenic Shock: Epinephrine versus Norepinephrine/Dobutamine. Critical Care Medicine, 39, 583-584.
http://dx.doi.org/10.1097/CCM.0b013e318208e381

 
 
Top