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Effectiveness of dopamine in patients with cardiogenic shock

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      Dopamine was evaluated in 24 patients with cardiogenic shock of various causes (systolic blood pressure less than 90 mm Hg or 60 mm Hg below the patient's usual level as recorded by intraarterial needle, average urinary flow less than 20 ml/hour without diuretic therapy). Dopamine was not given until hypovolemia was corrected, as judged by left ventricular filling pressure (18 patients) or central venous pressure. Twelve patients survived the shock episode, 5 of whom are alive 7 to 24 months later. The 12 survivors of shock included all 6 patients (100 percent) with shock after open heart surgery; 3 of 10 (30 percent) with acute myocardial infarction; 1 of 4 (25 percent) with severe heart failure; and 2 of 4 (50 percent) with shock after noncardiac surgery. Seven patients, including 6 of the 12 survivors, received no pressor agent other than dopamine. In 12 nonsurvivors hourly urinary flow increased from 10 ± 2.3 (standard error of the mean) to a maximum of 101 ± 55 ml/hour (not significant), but 8 of these patients had virtually no change in urinary flow during dopamine therapy. In the 12 survivors, there was a larger increment in urinary flow [from 25.7 ± 11 to 250 ± 59 ml/hour (P <0.001)]. In survivors, left ventricular filling pressure decreased during dopamine infusion from 27 ± 2.4 to 18 ± 2.3 mm Hg (P <0.05); in nonsurvivors it was unchanged (27 mm Hg). Survivors had a small but significant decrease in heart rate and a significant increase in mean arterial pressure compared with values in non-survivors. In survivors, maintenance doses of dopamine averaged 9.1 μg/kg per min. In 3 of 4 patients receiving intraaortic balloon counter-pulsation, 2 of whom survived, dopamine augmented urinary flow from an average of 20 to 208 ml/hour. We conclude that dopamine is useful, either alone or in conjunction with other pressor agents, for the treatment of cardiogenic shock, particularly in patients with diminished urinary flow and hypotension after cardiopulmonary bypass.
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