Dobutamine-norepinephrine, but not vasopressin, restores the ventriculoarterial matching in experimental cardiogenic shock

We assessed the hemodynamic effects of guideline therapy in experimental cardiogenic shock and compared this treatment with a combination containing an alternative vasopressor (arginine vasopressin, AVP). Our hypothesis was that combined dobutamine-norepinephrine still is the superior inopressor therapy assessed by ventriculoarterial matching in both systole and diastole. Cardiogenic shock (CS) was induced by coronary microembolization in 16 pigs. Dobutamine (Dobu, 2ug/kg/min) alone and combined with either norepinephrine (NE, 100 ng/kg/min) or the pure vasopressor AVP (0.001 u/kg/min) were infused. In CS, Dobu increased cardiac output (CO) and central venous oxygen saturation (SVO₂) from 74 ± 3 mL/kg and 37 ± 2% to 103 ± 8 mL/kg and 49 ± 3%. Adding NE resulted in a further improvement of CO (125 ± 9 mL/kg) and SVO₂ (59 ± 4%) because of an increased heart rate and contractility with minimal change in systemic vascular resistance. Also, energy transfer from the ventricle to the arterial system was restored partly by Dobu and was normalized by supplementing NE. In contrast, supplemental AVP further worsened the shock state by decreasing CO (70 ± 6 mL/kg) and SVO₂ (45 ± 5%) compared with Dobu alone. Combined Dobu-NE has an efficient hemodynamic profile in CS. A pure afterload increasing substance used in acute ischemic CS aggravates the shock state by causing a ventriculoarterial mismatch despite its use in combination with an inotropic compound.

Abbreviations: AVP, arginine vasopressin, CO, cardiac output, CS, cardiogenic shock, CVP, central venous pressure, Dobu, dobutamine, dP/dt, derivative of ventricular pressure, EDV, end diastolic volume, EDPVR, end diastolic pressure volume relationship, E_ES, end systolic elastance, EF, ejection fraction, ESPVR, end systolic pressure volume relationship, ESV, end systolic volume, MAP, mean arterial pressure, MPAP, mean pulmonary artery pressure, NE, norepinephrine, PCWP, pulmonary capillary wedge pressure, PRSW, preload recruitable stroke work, PV, pressure-volume, SD, standard deviation, SV, stroke volume, SVO₂, central venous oxygen saturation, SVR, systemic vascular resistance, SW, stroke work, Tau, time constant of isovolumetric relaxation, V0, x-axis intercept of the ESPVR, VCO, vena cava occlusion