Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome.

Abstract:

BACKGROUND:Cardiogenic shock (CS) and low cardiac output syndrome (LCOS) as complications of acute myocardial infarction (AMI), heart failure (HF) or cardiac surgery are life-threatening conditions. While there is a broad body of evidence for the treatment of people with acute coronary syndrome under stable haemodynamic conditions, the treatment strategies for people who become haemodynamically unstable or develop CS remain less clear. We have therefore summarised here the evidence on the treatment of people with CS or LCOS with different inotropic agents and vasodilative drugs. This is the first update of a Cochrane review originally published in 2014. OBJECTIVES:To assess efficacy and safety of cardiac care with positive inotropic agents and vasodilator strategies in people with CS or LCOS due to AMI, HF or cardiac surgery. SEARCH METHODS:We searched CENTRAL, MEDLINE, Embase and CPCI-S Web of Science in June 2017. We also searched four registers of ongoing trials and scanned reference lists and contacted experts in the field to obtain further information. No language restrictions were applied. SELECTION CRITERIA:Randomised controlled trials in people with myocardial infarction, heart failure or cardiac surgery complicated by cardiogenic shock or LCOS. DATA COLLECTION AND ANALYSIS:We used standard methodological procedures expected by Cochrane. MAIN RESULTS:We identified 13 eligible studies with 2001 participants (mean or median age range 58 to 73 years) and two ongoing studies. We categorised studies into eight comparisons, all against cardiac care and additional other active drugs or placebo. These comparisons investigated the efficacy of levosimendan versus dobutamine, enoximone or placebo, epinephrine versus norepinephrine-dobutamine, amrinone versus dobutamine, dopexamine versus dopamine, enoximone versus dopamine and nitric oxide versus placebo.All trials were published in peer-reviewed journals, and analysis was done by the intention-to-treat (ITT) principle. Twelve of 13 trials were small with few included participants. Acknowledgement of funding by the pharmaceutical industry or missing conflict of interest statements emerged in five of 13 trials. In general, confidence in the results of analysed studies was reduced due to serious study limitations, very serious imprecision or indirectness. Domains of concern, which show a high risk of more than 50%, include performance bias (blinding of participants and personnel) and bias affecting the quality of evidence on adverse events.Levosimendan may reduce short-term mortality compared to a therapy with dobutamine (RR 0.60, 95% CI 0.37 to 0.95; 6 studies; 1776 participants; low-quality evidence; NNT: 16 (patients with moderate risk), NNT: 5 (patients with CS)). This initial short-term survival benefit with levosimendan vs. dobutamine is not confirmed on long-term follow up. There is uncertainty (due to lack of statistical power) as to the effect of levosimendan compared to therapy with placebo (RR 0.48, 95% CI 0.12 to 1.94; 2 studies; 55 participants, very low-quality evidence) or enoximone (RR 0.50, 95% CI 0.22 to 1.14; 1 study; 32 participants, very low-quality evidence).All comparisons comparing other positive inotropic, inodilative or vasodilative drugs presented uncertainty on their effect on short-term mortality with very low-quality evidence and based on only one RCT. These single studies compared epinephrine with norepinephrine-dobutamine (RR 1.25, 95% CI 0.41 to 3.77; 30 participants), amrinone with dobutamine (RR 0.33, 95% CI 0.04 to 2.85; 30 participants), dopexamine with dopamine (no in-hospital deaths from 70 participants), enoximone with dobutamine (two deaths from 40 participants) and nitric oxide with placebo (one death from three participants). AUTHORS' CONCLUSIONS:Apart from low quality of evidence data suggesting a short-term mortality benefit of levosimendan compared with dobutamine, at present there are no robust and convincing data to support a distinct inotropic or vasodilator drug-based therapy as a superior solution to reduce mortality in haemodynamically unstable people with cardiogenic shock or LCOS.Considering the limited evidence derived from the present data due to a generally high risk of bias and imprecision, it should be emphasised that there remains a great need for large, well-designed randomised trials on this topic to close the gap between daily practice in critical care medicine and the available evidence. It seems to be useful to apply the concept of 'early goal-directed therapy' in cardiogenic shock and LCOS with early haemodynamic stabilisation within predefined timelines. Future clinical trials should therefore investigate whether such a therapeutic concept would influence survival rates much more than looking for the 'best' drug for haemodynamic support.

authors

Schumann J,Henrich EC,Strobl H,Prondzinsky R,Weiche S,Thiele H,Werdan K,Frantz S,Unverzagt S

doi

10.1002/14651858.CD009669.pub3

subject

Has Abstract

pub_date

2018-01-29 00:00:00

pages

CD009669

issn

1469-493X

journal_volume

1

pub_type

杂志文章,meta分析,评审
  • Anti-epileptic drugs for preventing seizures following acute traumatic brain injury.

    abstract:BACKGROUND:Seizure activity in the early post-traumatic period following head injury may cause secondary brain damage as a result of increased metabolic demands, raised intracranial pressure and excess neurotransmitter release. OBJECTIVES:To determine the effects of prophylactic anti-epileptic agents for acute traumat...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000173

    authors: Schierhout G,Roberts I

    更新日期:2001-01-01 00:00:00

  • Allergen-specific oral immunotherapy for peanut allergy.

    abstract:BACKGROUND:Peanut allergy is one of the most common forms of food allergy encountered in clinical practice.  In most cases, it does not spontaneously resolve; furthermore, it is frequently implicated in acute life-threatening reactions. The current management of peanut allergy centres on meticulous avoidance of peanuts...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009014.pub2

    authors: Nurmatov U,Venderbosch I,Devereux G,Simons FE,Sheikh A

    更新日期:2012-09-12 00:00:00

  • Non-nutritive sucking for gastro-oesophageal reflux disease in preterm and low birth weight infants.

    abstract:BACKGROUND:Gastro-oesophageal reflux (GOR) is commonly diagnosed in the neonatal population (DiPietro 1994), and generally causes few or no symptoms (Vandenplas 2009). Conversely, gastro-oesophageal reflux disease (GORD) refers to GOR that causes troublesome symptoms with or without complications such as damage to the ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009817.pub2

    authors: Psaila K,Foster JP,Richards R,Jeffery HE

    更新日期:2014-10-15 00:00:00

  • Acupuncture for slowing the progression of myopia in children and adolescents.

    abstract:BACKGROUND:Myopia (near-sightedness or short-sightedness) is one of the three commonly detected refractive (focusing) errors. Acupuncture is the stimulation of acupuncture points by various methods including needle insertion and acupressure. It is often used by traditional Chinese medicine practitioners to treat myopia...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007842.pub2

    authors: Wei ML,Liu JP,Li N,Liu M

    更新日期:2011-09-07 00:00:00

  • Antioxidants for male subfertility.

    abstract:BACKGROUND:Between 30% to 80% of male subfertility cases are considered to be due to the damaging effects of oxidative stress on sperm. Oral supplementation with antioxidants may improve sperm quality by reducing oxidative stress.   OBJECTIVES:This Cochrane review aimed to evaluate the effect of oral supplementation w...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007411.pub2

    authors: Showell MG,Brown J,Yazdani A,Stankiewicz MT,Hart RJ

    更新日期:2011-01-19 00:00:00

  • Indoor residual spraying for preventing malaria.

    abstract:BACKGROUND:Primary malaria prevention on a large scale depends on two vector control interventions: indoor residual spraying (IRS) and insecticide-treated mosquito nets (ITNs). Historically, IRS has reduced malaria transmission in many settings in the world, but the health effects of IRS have never been properly quanti...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006657.pub2

    authors: Pluess B,Tanser FC,Lengeler C,Sharp BL

    更新日期:2010-04-14 00:00:00

  • Enamel etching for bonding fixed orthodontic braces.

    abstract:BACKGROUND:Acid etching of tooth surfaces to promote the bonding of orthodontic attachments to the enamel has been a routine procedure in orthodontic treatment since the 1960s. Various types of orthodontic etchants and etching techniques have been introduced in the past five decades. Although a large amount of informat...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005516.pub2

    authors: Hu H,Li C,Li F,Chen J,Sun J,Zou S,Sandham A,Xu Q,Riley P,Ye Q

    更新日期:2013-11-25 00:00:00

  • Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.

    abstract:BACKGROUND:Infants born preterm (before 37 weeks' gestation) have poorer outcomes than infants at term, particularly if born before 32 weeks. Early cord clamping has been standard practice over many years, and enables quick transfer of the infant to neonatal care. Delayed clamping allows blood flow between the placenta...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章

    doi:10.1002/14651858.CD003248.pub4

    authors: Rabe H,Gyte GM,Díaz-Rossello JL,Duley L

    更新日期:2019-09-17 00:00:00

  • Families and Schools Together (FAST) for improving outcomes for children and their families.

    abstract:BACKGROUND:Parents and carers have a major influence on children's learning and development from birth, through the school years, and into adulthood. Parental contributions to education include providing a secure environment in which to learn, providing intellectual stimulation, transmitting social norms and values, sh...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD012760.pub2

    authors: Valentine JC,Leach SM,Fowler AP,Stojda DK,Macdonald G

    更新日期:2019-07-31 00:00:00

  • Intra-uterine insemination for unexplained subfertility.

    abstract:BACKGROUND:Intra-uterine insemination (IUI) is a widely-used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treat...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD001838.pub6

    authors: Ayeleke RO,Asseler JD,Cohlen BJ,Veltman-Verhulst SM

    更新日期:2020-03-03 00:00:00

  • Clonazepam add-on therapy for drug-resistant epilepsy.

    abstract:BACKGROUND:This is an updated version of the original Cochrane Review published in 2018, Issue 5. Epilepsy affects over 70 million people worldwide, and nearly a quarter of patients with seizures have drug-resistant epilepsy. People with drug-resistant epilepsy have increased risks of premature death, injuries, psychos...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章

    doi:10.1002/14651858.CD012253.pub3

    authors: Song L,Liu F,Liu Y,Zhang R,Ji H,Jia Y

    更新日期:2020-04-20 00:00:00

  • Maternal antigen avoidance during pregnancy for preventing atopic disease in infants of women at high risk.

    abstract:OBJECTIVES:To assess the effects of prescribing an antigen avoidance diet during pregnancy on the nutritional status of the mother and newborn and on the development of atopic disease in the child. The main focus is on women at high risk for giving birth to an atopic child, based on a history of atopic disease in the m...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000133

    authors: Kramer MS

    更新日期:2000-01-01 00:00:00

  • Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease.

    abstract:BACKGROUND:Lung disease in preterm infants is often complicated with lung edema. OBJECTIVES:The aim of this review was to assess the risks and benefits of administration of a diuretic acting on the loop of Henle (loop diuretic) in preterm infants with or developing chronic lung disease (CLD). Primary objectives were t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001453

    authors: Brion LP,Primhak RA

    更新日期:2002-01-01 00:00:00

  • Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children.

    abstract:BACKGROUND:In children with urinary tract infection (UTI), only those with pyelonephritis (and not cystitis) are at risk for developing long-term renal sequelae. If non-invasive biomarkers could accurately differentiate children with cystitis from children with pyelonephritis, treatment and follow-up could potentially ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD009185.pub2

    authors: Shaikh N,Borrell JL,Evron J,Leeflang MM

    更新日期:2015-01-20 00:00:00

  • Vinpocetine for acute ischaemic stroke.

    abstract:BACKGROUND:Vasoactive and neuroprotective drugs such as vinpocetine are used to treat stroke in some countries. OBJECTIVES:To assess the effect of vinpocetine in acute ischaemic stroke. SEARCH STRATEGY:We searched the Cochrane Stroke Group Trials Register (last searched February 2007), MEDLINE (1966 to February 2007)...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000480.pub2

    authors: Bereczki D,Fekete I

    更新日期:2008-01-23 00:00:00

  • Interventions for treating bisphosphonate-related osteonecrosis of the jaw (BRONJ).

    abstract:BACKGROUND:Bisphosphonate drugs can be used to prevent and treat osteoporosis and to reduce symptoms and complications of metastatic bone disease; however, they are associated with a rare but serious adverse event: osteonecrosis of the maxillary and mandibular bones. This condition is called bisphosphonate-related oste...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD008455.pub2

    authors: Rollason V,Laverrière A,MacDonald LC,Walsh T,Tramèr MR,Vogt-Ferrier NB

    更新日期:2016-02-26 00:00:00

  • Early use of inhaled corticosteroids in the emergency department treatment of acute asthma.

    abstract:BACKGROUND:Systemic corticosteroid therapy is central to the management of acute asthma The use of inhaled corticosteroids may also be beneficial in this setting. OBJECTIVES:To determine the benefit of inhaled corticosteroids for the treatment of patients with acute asthma managed in the emergency department (ED). SE...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD002308

    authors: Edmonds ML,Camargo CA Jr,Pollack CV Jr,Rowe BH

    更新日期:2003-01-01 00:00:00

  • Interventions for preventing delirium in hospitalised patients.

    abstract:BACKGROUND:Delirium is a common mental disorder with serious adverse outcomes in hospitalised patients. It is associated with increases in mortality, physical morbidity, length of hospital stay, institutionalisation and costs to healthcare providers. A range of risk factors has been implicated in its aetiology, includi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD005563.pub2

    authors: Siddiqi N,Stockdale R,Britton AM,Holmes J

    更新日期:2007-04-18 00:00:00

  • Polyunsaturated fatty acid supplementation for schizophrenia.

    abstract:BACKGROUND:Limited evidence supports a hypothesis suggesting that schizophrenic symptoms may be the result of altered neuronal membrane structure and metabolism. This structure and metabolism is dependent on blood plasma levels of certain essential fatty acids and their metabolites. OBJECTIVES:To review the effects po...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001257

    authors: Joy CB,Mumby-Croft R,Joy LA

    更新日期:2003-01-01 00:00:00

  • Audit and feedback: effects on professional practice and health care outcomes.

    abstract:BACKGROUND:Audit and feedback has been identified as having the potential to change the practice of health care professionals. OBJECTIVES:To assess the effects of audit and feedback on the practice of health professionals and patient outcomes. SEARCH STRATEGY:We searched MEDLINE up to June 1997, the Research and Deve...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000259

    authors: Thomson O'Brien MA,Oxman AD,Davis DA,Haynes RB,Freemantle N,Harvey EL

    更新日期:2000-01-01 00:00:00

  • Simple behavioural and physical interventions for nocturnal enuresis in children.

    abstract:BACKGROUND:Nocturnal enuresis (bedwetting) is a socially disruptive and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs can be great. Simple behavioural methods of treat...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003637.pub2

    authors: Glazener CM,Evans JH

    更新日期:2004-01-01 00:00:00

  • Antibiotic regimens for the empirical treatment of newborn infants with necrotising enterocolitis.

    abstract:BACKGROUND:Although the exact aetiology of necrotising enterocolitis (NEC) remains unknown, research suggests that it is multifactorial; suspected pathophysiological mechanisms include immaturity, intestinal ischaemia, disruption of intestinal mucosal integrity, formula feeding, hyperosmolar load to the intestine, infe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007448.pub2

    authors: Shah D,Sinn JK

    更新日期:2012-08-15 00:00:00

  • Dressings and topical agents for preventing pressure ulcers.

    abstract:BACKGROUND:Pressure ulcers, localised injuries to the skin or underlying tissue, or both, occur when people cannot reposition themselves to relieve pressure on bony prominences. These wounds are difficult to heal, painful, expensive to manage and have a negative impact on quality of life. Prevention strategies include ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD009362.pub3

    authors: Moore ZE,Webster J

    更新日期:2018-12-06 00:00:00

  • Lay-led and peer support interventions for adolescents with asthma.

    abstract:BACKGROUND:Adolescents with asthma are at high risk of poor adherence with treatment. This may be compounded by activities that worsen asthma, in particular smoking. Additional support above and beyond routine care has the potential to encourage good self-management. We wanted to find out whether sessions led by their ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD012331.pub2

    authors: Kew KM,Carr R,Crossingham I

    更新日期:2017-04-19 00:00:00

  • Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease.

    abstract:BACKGROUND:Researchers have suggested that omega-3 polyunsaturated fatty acids from oily fish (long-chain omega-3 (LCn3), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), as well as from plants (alpha-linolenic acid (ALA)) benefit cardiovascular health. Guidelines recommend increasing omega-3-rich...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD003177.pub4

    authors: Abdelhamid AS,Brown TJ,Brainard JS,Biswas P,Thorpe GC,Moore HJ,Deane KH,AlAbdulghafoor FK,Summerbell CD,Worthington HV,Song F,Hooper L

    更新日期:2018-11-30 00:00:00

  • Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community.

    abstract:BACKGROUND:Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may cause death. Adrenaline (epinephrine) auto-injectors are recommended as the initial, potentially life-saving treatment of choice for anaphylaxis in the community, but they are not universally available and have limitations in t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD008935.pub2

    authors: Sheikh A,Simons FE,Barbour V,Worth A

    更新日期:2012-08-15 00:00:00

  • Audio recordings of consultations with doctors for parents of critically sick babies.

    abstract:BACKGROUND:Family centred care is an important part of neonatal intensive care. Ensuring effective communication in the neonatal intensive care unit (NICU) is a challenge but is crucial to the implementation of family centred care. Providing parents in NICU with audiotape recordings of their conversations with neonatol...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004502.pub2

    authors: Koh TH,Budge D,Butow P,Renison B,Woodgate P

    更新日期:2005-01-25 00:00:00

  • Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit.

    abstract:BACKGROUND:The need for sedation for neonates undergoing uncomfortable procedures in the neonatal intensive care unit (NICU) has often been overlooked. Proper sedation may reduce stress and avoid complications during procedures such as mechanical ventilation. Midazolam is a short acting benzodiazepine that has been inc...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD002052

    authors: Ng E,Taddio A,Ohlsson A

    更新日期:2000-01-01 00:00:00

  • Nutritional support in children and young people with cancer undergoing chemotherapy.

    abstract:BACKGROUND:It is well documented that malnutrition is a common complication of paediatric malignancy and its treatment. Malnutrition can often be a consequence of cancer itself or a result of chemotherapy. Nutritional support aims to reverse malnutrition seen at diagnosis, prevent malnutrition associated with treatment...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003298.pub3

    authors: Ward EJ,Henry LM,Friend AJ,Wilkins S,Phillips RS

    更新日期:2015-08-24 00:00:00

  • Herbal medicines for viral myocarditis.

    abstract:BACKGROUND:Herbal medicines are being used as a treatment for viral diseases such as viral myocarditis and numerous clinical trials have been conducted to investigate their efficacy. Despite this wealth of evidence, the role of herbal medicines in the treatment of viral myocarditis is yet to be established. This is an ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003711.pub4

    authors: Liu ZL,Liu ZJ,Liu JP,Kwong JS

    更新日期:2012-11-14 00:00:00