Norepinephrine and Dopamine Treatment for Shock Compared

Study finds overall death rates similar, but dopamine may pose danger in cardiogenic shock
By Jeff Muise
HealthDay Reporter

WEDNESDAY, March 3 (HealthDay News) -- In patients with shock, treatment with dopamine and norepinephrine results in similar overall death rates, but dopamine causes more adverse events and may pose a safety risk for patients in cardiogenic shock, according to a study in the March 4 issue of the New England Journal of Medicine.

Daniel De Backer, M.D., of the Université Libre de Bruxelles in Belgium, and colleagues randomized 1,679 patients with shock to first-line vasopressor treatment with either dopamine or norepinephrine. The study outcomes included mortality at 28 days, number of days without organ support, and adverse events.

The researchers found that mortality in the two treatment groups at 28 days was similar: 52.5 percent in the dopamine group and 48.5 percent in the norepinephrine group. However, arrhythmic events occurred more often in the dopamine group (24.1 percent) than the norepinephrine group (12.4 percent). Also, in subgroup analysis, dopamine was associated with higher mortality at 28 days in patients with cardiogenic shock than was norepinephrine, but not in patients with septic shock or hypovolemic shock.

"In summary, although the rate of death did not differ significantly between the group of patients treated with dopamine and the group treated with norepinephrine, this study raises serious concerns about the safety of dopamine therapy, since dopamine, as compared to norepinephrine, was associated with more arrhythmias and with an increased rate of death in the subgroup of patients with cardiogenic shock," the authors write.

One study author reported receiving consulting fees from the medical device company Covidien.

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