Network Meta-Analysis of the Safety of Drug Therapy for Cardiogenic Shock

Abstract

Objectives. (1) To conduct a network meta-analysis of clinical drugs used for cardiogenic shock and (2) provide evidence for the selection of medication for the treatment of this condition. Methods. PubMed, EMBASE, Cochrane library, China HowNet (CNKI), Wanfang database, and Weipu database were searched using keywords Dopamine, Dobutamine, Epinephrine, Adrenaline, Norepinephrine, Noradrenaline, Milrinone, Natriuretic peptide, Recombinant human brain natriuretic peptide, Levosimendan, Cardiac shock, and Cardiogenic shock. We select literature according to prespecified inclusion and exclusion criteria and record data such as drug type, mortality, and adverse reactions. Results. Twenty-eight of 1387 articles met inclusion criteria, comprising 1806 patients who suffered from cardiogenic shock. Dopamine, dobutamine, epinephrine, norepinephrine, milrinone, recombinant human brain natriuretic peptide, and levosimendan were all commonly used in the treatment of cardiogenic shock. Milrinone was most effective at reducing mortality and had the lowest incidence of adverse reactions. Conclusion. This network meta-analysis demonstrated that milrinone was the most effective medication at reducing mortality and adverse events in patients suffering from cardiogenic shock.

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

“…These data are supplemented by the work of Liao et al [58], who conducted a 'reticular network metaanalysis' of the safety of an array of possible therapies for CS, including levosimendan, dobutamine, milrinone, dopamine, adrenaline, noradrenaline, and recombinant human brain natriuretic peptide (RHBNP). Based on 28 studies that included 1806 patients, Liao et al concluded that milrinone was the preferred agent based on its efficacy and potential for side effects, with levosimendan and RHBNP as other strong candidates.…”

Inotropic support in cardiogenic shock: who leads the battle, milrinone or dobutamine?

“…However, it suggests that the use of Levosimendan decreases short-term mortality, compared to Dobutamine Uhlig et al [ 41 ] To evaluate the safety, efficacy and efficiency of the use of inotropics and vasodilators in cardiogenic shock secondary to acute myocardial infarction Systematic review and meta-analysis of randomized clinical trials, including a total of 2385 patients Serious limitations due to risk of bias were evidenced. Nevertheless, it was observed that Levosimendan decreases short and long term mortality, compared to Dobutamine, but the latter improves survival compared to Epinephrine/Norepinephrine There is insufficient evidence to determine that there is a specific inotropic or vasodilator that reduces mortality in patients with cardiogenic shock Liao et al [ 42 ] To synthesize evidence on the most favorable choice of drugs for the management of cardiogenic shock Systematic review and meta-analysis of randomized clinical trials, including a total of 1806 patients. Among the agents evaluated (Dopamine, Dobutamine, Epinephrine, Norepinephrine, Milrinone and Levosimendan), Milrinone has the highest reduction in mortality and a low incidence of adverse events Milrinone is the most effective therapeutic agent for reducing mortality in patients with cardiogenic shock, with a good risk-benefit balance with respect to adverse events Karami et al [ 43 ] To evaluate the routine effect of inotropic and vasopressor drugs on mortality in patients with cardiogenic shock secondary to acute myocardial infarction Systematic review and meta-analysis of randomized clinical trials and observational studies, including 2478 patients No differences were found between the use of Adrenaline, Noradrenaline, Vasopressin, Milrinone, Levosimendan, Dobutamine or Dopamine, on mortality.…”

“…During the literature review, 6 systematic reviews and meta-analyses were found that met the inclusion criteria [ [39] , [40] , [41] , [42] , [43] , [44] ].…”

The medical treatment of cardiogenic shock: cardiovascular drugs

“…The impact of phosphodiesterase inhibitors on the outcome of patients with cardiogenic shock has not been well studied [39 ▪ ]. Network meta-analysis including nonrandomized trial suggest some benefit for milrinone [42 ▪ ]. This was not confirmed in a randomized study comparing dobutamine and milrinone in 192 patients reported no difference in the primary composite end-point aggregating in-hospital mortality, nonfatal myocardial infarction, stroke, new initiation of renal replacement therapy, need for mechanical support device or cardiac transplant, or cardiac arrest with successful resuscitation [43 ▪▪ ].…”

“…The impact of levosimendan on outcome is not well defined. Although meta-analyses suggest some benefit in survival in acute heart failure [39 ▪ ], the effects in cardiogenic shock remains less well defined [42 ▪ ].…”