Milrinone or Dobutamine in Cardiogenic Shock?

Is your institution a milrinone shop or a dobutamine shop? Or do you have a mixed shop?
It seems that most institutions are accustomed to use mostly one or the other in cardiogenic shock.
Some argue that milrinone is better.
Some argue that dobutamine is better.
But do we know the answer?
This was answered late in 2021 in the New England Journal of Medicine.
Hat tip to the authors. Download the article for yourself as this is not medical advice.
They randomized 192 patients in cardiogenic shock to either milrinone or dobutamine.
Baseline characteristics were similar between the two groups.
They had a cardiac index of less than 1.8.
Most patients did not have a PA catheter.
The primary outcome is a composite outcome with included numerous parameters.
There was no difference between the two groups.
They tried to tease out benefits in the subgroup analysis of the primary outcome.
There appears to be a trend where milrinone is better, but trends don’t mean anything.
The secondary outcomes were also numerous.
Due to the faster metabolism of dobutamine with a half life of 2 minutes versus >2 hours in milrinone, I would have figured that there would be a difference in length of stay or total time receiving inotropes but this was not the case.
There was no difference in any of these either.
All in all, there was no difference between milrinone and dobutamine in cardiogenic shock.
Keep doing whatever you were doing before.
If you want to learn more about mechanical circulatory support in cardiogenic shock, CLICK HERE.

Milrinone or Dobutamine in Cardioge...
Milrinone or Dobutamine in Cardiogenic Shock?

Citation for Dobutamine vs Milrinone

Mathew R, Di Santo P, Jung RG, Marbach JA, Hutson J, Simard T, Ramirez FD, Harnett DT, Merdad A, Almufleh A, Weng W, Abdel-Razek O, Fernando SM, Kyeremanteng K, Bernick J, Wells GA, Chan V, Froeschl M, Labinaz M, Le May MR, Russo JJ, Hibbert B. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med. 2021 Aug 5;385(6):516-525. doi: 10.1056/NEJMoa2026845. PMID: 34347952.
Link to Article
Link to FULL FREE PDF

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Podcast Script

Is your institution a milrinone shop or a dobutamine shop? Or do you have a mixed shop?
It seems that most institutions are accustomed to use mostly one or the other in cardiogenic shock.
Some argue that milrinone is better.
Some argue that dobutamine is better.
But do we know the answer?
This was answered late in 2021 in the New England Journal of Medicine.
Hat tip to the authors. Download the article for yourself as it is completely free. This is not medical advice.
They randomized 192 patients in cardiogenic shock to either milrinone or dobutamine.
Baseline characteristics were similar between the two groups.
They had a cardiac index of less than 1.8.
Most patients did not have a PA catheter.
The primary outcome is a composite outcome with included numerous parameters.
There was no difference between the two groups.
They tried to tease out benefits in the subgroup analysis of the primary outcome.
There appears to be a trend where milrinone is better, but trends don’t mean anything.
The secondary outcomes were also numerous.
Due to the faster metabolism of dobutamine with a half life of 2 minutes versus >2 hours in milrinone, I would have figured that there would be a difference in length of stay or total time receiving inotropes but this was not the case.
There was no difference in any of these either.
All in all, there was no difference between milrinone and dobutamine in cardiogenic shock.
Keep doing whatever you were doing before.