Mathew R, et al. N Engl J Med. 2021 Aug 5;385(6):516-525.
Question and Methods: The authors performed a double-blinded RCT to determine if milrinone was superior to dobutamine for the treatment of cardiogenic shock in the ICU.
Findings: Primary composite outcome occurred in 49% of milrinone group vs 54% in dobutamine group (ARR 0.05 [90% CI -0.09-0.19], RR 0.9 [90% CI 0.69-1.19 p=0.047]).
Limitations: Major limitations of this study include the small sample size, use of composite outcome, and potential for selection bias regarding excluded patients.
Interpretation: Milrinone was not found to be superior to dobutamine for the treatment of cardiogenic shock in the ICU.
Dr. Kathleen O'Connell is an Emergency Medicine resident in the Department of Emergency Medicine, University of Ottawa. She is an senior editor with the Digital Scholarship and Knowledge Dissemination team for the EMOttawaBlog.
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.