CARDIOGENIC SHOCK: Edited by Fabio GuarracinoThe medical treatment of cardiogenic shock: cardiovascular drugsDe Backer, Daniela; Arias Ortiz, Julianb; Levy, Brunoc,d,e Author Information aDepartment of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium bDepartment of Intensive Care, National ECMO Center, Calderon Guardia Hospital, Universidad de Costa Rica, San José, Costa Rica cCHRU Nancy, Service de Réanimation Médicale Brabois, Pôle Cardiovasculaire et Réanimation Médicale, Hôpital Brabois, Vandoeuvre les Nancy, France dINSERM U 1116, Groupe Choc, Equipe 2, Faculté de Médecine, Vandoeuvre les Nancy, France eUniversité de Lorraine, Faculté de Médecine, Nancy, France Correspondence to Dr Daniel De Backer, Department of Intensive Care, CHIREC Hospitals, Boulevard du Triomphe 201, B-1160 Brussels, Belgium. Tel: +32 2 434 9324; fax: +32 2 434 9312; e-mail: [email protected] Current Opinion in Critical Care: August 2021 - Volume 27 - Issue 4 - p 426-432 doi: 10.1097/MCC.0000000000000822 Buy Metrics Abstract Purpose of review To discuss the use of vasopressors and inotropes in cardiogenic shock. Recent findings The classic form or cardiogenic shock requires administration of inotropic and/or vasopressor agents to try to improve the impaired tissue perfusion. Among vasopressors various alpha-adrenergic agents, vasopressin derivatives and angiotensin can be used. The first-line therapy remains norepinephrine as it is associated with minimal adverse effects and appears to be associated by the best outcome in network meta-analyses. On the contrary, epinephrine is associated with an increased incidence of refractory shock and observational studies suggest an increased risk of death. Vasopressin may be an excellent alternative in tachycardiac patients or in the presence of pulmonary hypertension. Concerning inotropic agents, dobutamine is the first-line agent but levosimendan is an excellent alternative or additional agent in cases not responding to dobutamine. The impact on outcome of inotropic agents remains controversial. Summary Recent studies have refined the position of the various vasopressor and inotropic agents. Norepinephrine is recommended as first-line vasopressor agent by various guidelines. Among inotropic agents, selection between the agents should be individualized and based on the hemodynamic response. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.