Risk stratification in cardiogenic shock: from clinical utility to improving outcomes

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

“…However, it should be noted that if during shock there is a decrease in cardiac output but maintenance of peripheral vascular resistance, Dobutamine can regulate blood pressure and hemodynamics without problem. However, if the decrease in peripheral vascular resistance is severe and the increase in cardiac output is not proportional, a state of persistent hypotension with vasodilatory shock may occur [ [25] , [26] , [27] ]. Considering the half-life of Dobutamine (<2 min), this agent achieves a rapid compensation of cardiac output in patients with post-infarction shock, which is favorable even in cases requiring rapid stabilization for transfer to specialized management.…”

“…Even the combination of Milrinone with a β1-agonist can more effectively regulate cardiac output, but could lead to severe adverse effects. Although it is the drug of choice in patients with low cardiac output and high peripheral vascular resistance, it should be used with caution because of the risk of hypotension and worsening of shock [ 6 , [23] , [24] , [25] ]. So far, it can be observed that both Dobutamine and Milrinone are potent therapeutic agents, but they should be used under certain considerations and taking into account some physiological and pathophysiological factors.…”