Inotropic and vasodilator strategies in people with cardiogenic shock or low cardiac output

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

Review question

We reviewed evidence of the treatment with different inotropic agents and vasodilative drugs for their effects on mortality in people with cardiogenic shock (CS) or low cardiac output syndrome (LCOS).


CS and LCOS still remain life-threatening complications. Inotropic and vasoactive drugs are potent, but potentially harmful agents. Their benefits and harms are associated with mortality.

Study characteristics

This evidence is current to June 2017. We included 13 studies with 2001 participants with CS or LCOS as complications of myocardial infarction, heart failure or cardiac surgery, with follow-up periods between the length of the recovery period up to 12 months. Four studies were funded by a drug manufacturer.

Key results

We compared different approaches to standard therapies with possible addition of inotropic or vasoconstrictive drugs as levosimendan, dobutamine, enoximone, epinephrine. This review presents low-quality evidence that levosimendan compared to dobutamine reduces short-term mortality. The survival benefit with levosimendan vs. dobutamine is not confirmed on long-term follow up. Very low-quality evidence shows uncertainty around the effect of levosimendan compared to placebo or enoximone. Very low-quality evidence shows uncertainty on the comparison of epinephrine with norepinephrine-dobutamine, amrinone or enoximone with dobutamine, dopexamine with dopamine, and nitric oxide with placebo.

Quality of evidence

We have reduced confidence in the results of the studies that we analysed (low- or very low-quality evidence) due to serious study limitations, very serious imprecision or indirectness.

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