심장수술 후 발생한 쇼크의 치료로서Dopamine 과 Norepinephrine 에 대한 비교 연구

Abstract

Background: Shock after cardiac surgery is a frequent but life-threatening condition. Intensive management with the use of inotropic agents is essential to treat post-cardiotomy shock. However, the ideal vasoactive agent remains controversial. We compared dopamine and norepinephrine to treat post-cardiac surgery shock. Methods: Patients with shock following cardiac surgeries were randomly assigned to receive either dopamine or norepinephrine as first-line vasopressors. Persistent shock despite maximal doses of drug infusion (dopamine 20 mcg/kg/min, norepinephrine 0.2 mcg/kg/min) or intolerance to first-line therapy owing to the development of tachyarrhythmia, necessitated the administration of second-line vasoactive inotropes (epinephrine and vasopressin). The primary endpoint was new-onset tachyarrhythmia (supraventricular, ventricular, or sinus tachycardia) during drug infusion. Secondary endpoints included all-cause mortality, requirement of second-line vasoactive inotropes, and major postoperative complications observed within 30 days of drug initiation. Results: At the planned interim analysis of 100 patients (48 administered dopamine and 50 norepinephrine, 2 drop-outs), a futility boundary for the primary endpoint was crossed, and the study was discontinued. Intergroup baseline characteristics were similar. New-onset tachyarrhythmia occurred in 12 patients in the dopamine and 1 patient in the norepinephrine group, showing a statistically significant difference (odds ratio [OR] 16.3, 95% confidence interval [CI], 2.0–131.3, P=0.009). The requirement for additional vasoactive inotropes was significantly more common in the dopamine group (OR 52.7, 95% CI 13.7–202.7, P<0.001). Other components of secondary endpoints showed intergroup similarity. Conclusions: Dopamine used as a first-line vasopressor for shock after cardiac surgery was associated with a higher risk of tachyarrhythmic events and a greater need for second-line vasoactive inotropes than that observed with norepinephrine.