DOREMI
Trial question
Is milrinone superior to dobutamine for the treatment of cardiogenic shock?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 192
192 patients (70 female, 122 male).
Inclusion criteria: adult patients with cardiogenic shock.
Key exclusion criteria: pregnancy, out-of-hospital cardiac arrest, healthcare team preference for use of specific inotrope.
Interventions
N=96 milrinone (at a dose of 0.125 mcg/kg/min to > 0.500 mcg/kg/min).
N=96 dobutamine (at a dose of 2.5 mcg/kg/min to > 10.0 mcg/kg/min).
Primary outcome
In-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal MI, transient ischemic attack or stroke diagnosed by a neurologist, or initiation of renal replacement therapy
49%
54%
54.0 %
40.5 %
27.0 %
13.5 %
0.0 %
Milrinone
Dobutamine
No significant
difference ↔
No significant difference in in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal MI, TIA or stroke diagnosed by a neurologist, or initiation of RRT (49% vs. 54%; RR 0.9, 95% CI 0.69 to 1.19).
Secondary outcomes
No significant difference in in-hospital death (37% vs. 43%; RR 0.85, 95% CI 0.6 to 1.21).
No significant difference in resuscitated cardiac arrest (7% vs. 9%; HR 0.78, 95% CI 0.29 to 2.07).
No significant difference in receipt of mechanical circulatory support (12% vs. 15%; HR 0.78, 95% CI 0.36 to 1.71).
Safety outcomes
No significant differences in serum lactate level, serum creatinine level, HR, arrhythmias.
Conclusion
In adult patients with cardiogenic shock, milrinone was not superior to dobutamine with respect to a in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal MI, TIA or stroke diagnosed by a neurologist, or initiation of RRT.
Reference
Rebecca Mathew, Pietro Di Santo, Richard G Jung et al. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock. N Engl J Med. 2021 Aug 5;385(6):516-525.
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