Assessing Catecholamine Treatment Initiation Options: Norepinephrine vs Dopamine for Cardiogenic Shock

Summary

The goal of this multicenter, open-label, randomized clinical trial is to learn whether norepinephrine or dopamine is more effective and safer as the first-line vasoactive drug for treating cardiogenic shock in adults. Cardiogenic shock is a life-threatening condition in which the heart cannot pump enough blood to supply the body. The main questions this study aims to answer are: Does norepinephrine reduce the risk of death or worsening cardiogenic shock compared with dopamine? Does norepinephrine lead to fewer complications such as arrhythmias, the need for mechanical circulatory support, or cardiac arrest? Researchers will compare norepinephrine and dopamine to see which drug better stabilizes blood pressure, improves tissue perfusion, and prevents progression of shock during the early phase of treatment. Participants will: Be randomly assigned to receive either norepinephrine or dopamine as the first vasoactive drug Receive treatment and monitoring based on current clinical guidelines for cardiogenic shock Undergo regular assessments of blood pressure, laboratory values, heart rhythm, and organ function during hospitalization Be followed for outcomes at 1 month, 6 months, and 1 year after enrollment This study aims to provide evidence that will help determine which initial vasoactive drug offers better outcomes for patients with cardiogenic shock and guide future treatment recommendations.

Timeline

Start

2026-05-31

Primary completion

2031-05-31

Completion

2032-05-31

Publications

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• Background Naidu SS, Baran DA, Jentzer JC, Hollenberg SM, van Diepen S, Basir MB, Grines CL, Diercks DB, Hall S, Kapur NK, Kent W, Rao SV, Samsky MD, Thiele H, Truesdell AG, Henry TD. SCAI SHOCK Stage Classification Expert Consensus Update: A Review and Incorporation of Validation Studies: This statement was endorsed by the American College of Cardiology (ACC), American College of Emergency Physicians (ACEP), American Heart Association (AHA), European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC), International Society for Heart and Lung Transplantation (ISHLT), Society of Critical Care Medicine (SCCM), and Society of Thoracic Surgeons (STS) in December 2021. J Soc Cardiovasc Angiogr Interv. 2022 Jan 30;1(1):100008. doi: 10.1016/j.jscai.2021.100008. eCollection 2022 Jan-Feb. No abstract available.
• Background Na SJ, Yang JH, Ko RE, Chung CR, Cho YH, Choi KH, Kim D, Park TK, Lee JM, Song YB, Choi JO, Hahn JY, Choi SH, Gwon HC. Dopamine versus norepinephrine as the first-line vasopressor in the treatment of cardiogenic shock. PLoS One. 2022 Nov 3;17(11):e0277087. doi: 10.1371/journal.pone.0277087. eCollection 2022.
• Background De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, Brasseur A, Defrance P, Gottignies P, Vincent JL; SOAP II Investigators. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010 Mar 4;362(9):779-89. doi: 10.1056/NEJMoa0907118.
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• Background Osman M, Syed M, Patibandla S, Sulaiman S, Kheiri B, Shah MK, Bianco C, Balla S, Patel B. Fifteen-Year Trends in Incidence of Cardiogenic Shock Hospitalization and In-Hospital Mortality in the United States. J Am Heart Assoc. 2021 Aug 3;10(15):e021061. doi: 10.1161/JAHA.121.021061. Epub 2021 Jul 28.
• Background Harjola VP, Lassus J, Sionis A, Kober L, Tarvasmaki T, Spinar J, Parissis J, Banaszewski M, Silva-Cardoso J, Carubelli V, Di Somma S, Tolppanen H, Zeymer U, Thiele H, Nieminen MS, Mebazaa A; CardShock Study Investigators; GREAT network. Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail. 2015 May;17(5):501-9. doi: 10.1002/ejhf.260. Epub 2015 Mar 28.
• Background Ueki Y, Mohri M, Matoba T, Tsujita Y, Yamasaki M, Tachibana E, Yonemoto N, Nagao K. Characteristics and Predictors of Mortality in Patients With Cardiovascular Shock in Japan - Results From the Japanese Circulation Society Cardiovascular Shock Registry. Circ J. 2016;80(4):852-9. doi: 10.1253/circj.CJ-16-0125. Epub 2016 Mar 18.
• Background Yang JH, Choi KH, Ko YG, Ahn CM, Yu CW, Chun WJ, Jang WJ, Kim HJ, Kim BS, Bae JW, Lee SY, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD, Lim SH, Cho S, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Gwon HC. Clinical Characteristics and Predictors of In-Hospital Mortality in Patients With Cardiogenic Shock: Results From the RESCUE Registry. Circ Heart Fail. 2021 Jun;14(6):e008141. doi: 10.1161/CIRCHEARTFAILURE.120.008141. Epub 2021 Jun 15.
• Background Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutierrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR; Peer Review Committee Members. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024 Jun 11;149(24):e1313-e1410. doi: 10.1161/CIR.0000000000001251. Epub 2024 May 14.

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