Milrinone Versus Dobutamine in Critically Ill Patients

• Status: Completed
• Trial end date: 2020-06-12
• Target enrollment: 0
• Participant gender: All

Summary

The investigators are interested in determining if there is a meaningful difference between two of the most commonly used medications used to improve the pumping function of the heart among critically ill patients admitted to the Coronary Care Unit (CCU) at the University of Ottawa Heart Institute (UOHI). To do this, the investigators will randomly assign patients who are felt to require use of these medications by their treating physicians to one of the two most commonly used agents in Canada: Milrinone or Dobutamine. Each patient will be closely monitored by their healthcare team, and their medication will be adjusted based on each patient's clinical status. Information from blood work (e.g. kidney and liver function, complete blood counts, and other markers of how effectively blood is circulating in the body), assessment of end-organ function (e.g. urine output, mentation), abnormal heart rhythms noted on monitoring and results of imaging studies (e.g. angiogram, echocardiograms.) will be collected for analysis. All patients will be followed for the duration of their hospital stay at UOHI.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Ottawa Heart Institute Research Corporation
• Treatments: Dobutamine; Milrinone; Phosphodiesterase 3 Inhibitors

Criteria

Inclusion Criteria:

• Have one or more of the following:

• Low cardiac output state, evidenced by sustained hypotension (systolic blood pressure <90 mmHg) and end organ dysfunction (altered level of consciousness, elevated lactate, renal or hepatic dysfunction)

• Clinical evidence of systemic and/or pulmonary congestion despite use of vasodilators and/or diuretics

• ACS complicated by cardiogenic shock (defined as persistent hypotension with systolic blood pressure <90 mmHg with severe reduction in cardiac index [<1.8 L/min/m2 without support or <2.2 L/min/m2 with support], left ventricular end-diastolic pressure >18 mmHg)

• Augmentation of cardiac output when patient already on maximal vasopressor therapy

• Or medical team's decision that patient needs inotropic therapy

Exclusion Criteria:

• Unwillingness or inability to provide informed consent by the patient or substitute decision maker for healthcare decisions

• Female participants who are currently pregnant

• Patients presenting with an out-of-hospital cardiac arrest (OOHCA)

• Healthcare team preference for use of specific inotrope (Milrinone or Dobutamine)