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2017 ; 96
(43
): e8402
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Dopamine versus norepinephrine in the treatment of cardiogenic shock: A
PRISMA-compliant meta-analysis
#MMPMID29069037
Rui Q
; Jiang Y
; Chen M
; Zhang N
; Yang H
; Zhou Y
Medicine (Baltimore)
2017[Oct]; 96
(43
): e8402
PMID29069037
show ga
BACKGROUND: Guidelines recommend that norepinephrine (NA) should be used to reach
the target mean arterial pressure (MAP) during cardiogenic shock (CS), rather
than epinephrine and dopamine (DA). However, there has actually been few studies
on comparing norepinephrine with dopamine and their results conflicts. These
studies raise a heat discussion. This study aimed to validate the effectiveness
of norepinephrine for treating CS in comparison with dopamine. METHODS: We
performed a meta-analysis of randomized controlled trials (RCTs) to assess pooled
estimates of risk ratio (RR) and 95% confidence interval (CI) for 28-day
mortality, incidence of arrhythmic events, gastrointestinal reaction, and some
indexes after treatment. RESULTS: Compared with dopamine, patients receiving
norepinephrine had a lower 28-day mortality (RR 1.611 [95% CI 1.219-2.129];
P?.001; P heterogeneity?=?.01), a lower risk of arrhythmic events (RR 3.426
[95% CI 2.120-5.510]; P?.001; P heterogeneity?=?.875) and a lower risk of
gastrointestinal reaction (RR 5.474 [95% CI 2.917-10.273]; P?.001; P
heterogeneity?=?0). In subgroup analyses on 28-day mortality by causes of CS,
there were more benefits from norepinephrine than dopamine in 2 subgroups.
CONCLUSIONS: Our analysis revealed that norepinephrine was associated with a
lower 28-day mortality, a lower risk of arrhythmic events, and gastrointestinal
reaction. No matter whether CS is caused by coronary heart disease or not,
norepinephrine is superior to dopamine for correcting CS on the 28-day mortality.