Milrinone Versus Dobutamine in Critically Ill Patients
Low Cardiac Output Syndrome, Cardiogenic Shock, Acute Coronary Syndrome
About this trial
This is an interventional treatment trial for Low Cardiac Output Syndrome focused on measuring Cardiogenic shock, Inotropes, Low cardiac output syndrome
Eligibility Criteria
Inclusion Criteria:
- Have one or more of the following:
- Low cardiac output state, evidenced by sustained hypotension (systolic blood pressure <90 mmHg) and end organ dysfunction (altered level of consciousness, elevated lactate, renal or hepatic dysfunction)
- Clinical evidence of systemic and/or pulmonary congestion despite use of vasodilators and/or diuretics
- ACS complicated by cardiogenic shock (defined as persistent hypotension with systolic blood pressure <90 mmHg with severe reduction in cardiac index [<1.8 L/min/m2 without support or <2.2 L/min/m2 with support], left ventricular end-diastolic pressure >18 mmHg)
- Augmentation of cardiac output when patient already on maximal vasopressor therapy
- Or medical team's decision that patient needs inotropic therapy
Exclusion Criteria:
- Unwillingness or inability to provide informed consent by the patient or substitute decision maker for healthcare decisions
- Female participants who are currently pregnant
- Patients presenting with an out-of-hospital cardiac arrest (OOHCA)
- Healthcare team preference for use of specific inotrope (Milrinone or Dobutamine)
Sites / Locations
- University of Ottawa Heart Institute
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Left ventricular [LV] +/- Biventricular dysfunction
Right ventricular [RV] dysfunction
Assessment of left ventricular [LV] or biventricular dysfunction will be based on clinical assessment, available imaging (echocardiogram, left ventriculogram, MUGA/RNA scan, cardiac MRI, etc.) and known past medical history (if available and contributory). Patients identified as having biventricular dysfunction will be randomized within the LV dysfunction arm of the trial. Patients in this arm will be randomized in a 1:1 fashion to Milrinone or Dobutamine.
Assessment of right ventricular [RV] dysfunction will be based on clinical assessment, available imaging (echocardiogram, left ventriculogram, MUGA/RNA scan, cardiac MRI, etc.) and known past medical history (if available and contributory). Patients in this arm will be randomized in a 1:1 fashion to Milrinone or Dobutamine.