CARDIOGENIC SHOCK: Edited by Benjamin HibbertInotrope and vasopressor use in cardiogenic shock: what, when and why?Hu, Kiraa; Mathew, Rebeccab,c Author Information aFaculty of Medicine, University of Ottawa bDivision of Cardiology cCAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada Correspondence to Rebecca Mathew, HS-407, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada. Tel: +613 696 7406; fax: +613 696 7248; e-mail: [email protected] Current Opinion in Critical Care: August 2022 - Volume 28 - Issue 4 - p 419-425 doi: 10.1097/MCC.0000000000000957 Buy Metrics Abstract Purpose of review Despite increasing interest in the management of cardiogenic shock (CS), mortality rates remain unacceptably high. The mainstay of supportive treatment includes vasopressors and inotropes. These medications are recommended in international guidelines and are widely used despite limited evidence supporting safety and efficacy in CS. Recent findings The OptimaCC trial further supports that norepinephrine should continue to be the first-line vasopressor of choice in CS. The CAPITAL DOREMI trial found that milrinone is not superior to dobutamine in reducing morbidity and mortality in CS. Two studies currently underway will offer the first evidence of the necessity of inotrope therapy in placebo-controlled trials: CAPITAL DOREMI2 will randomize CS patients to inotrope or placebo in the initial resuscitation of shock to evaluate the efficacy of inotrope therapy and LevoHeartShock will examine the efficacy of levosimendan against placebo in early CS requiring vasopressor therapy. Summary Review of the current literature fails to show significant mortality benefit with any specific vasopressor or inotropic in CS patients. The upcoming DOREMI 2 and levosimendan versus placebo trials will further tackle the question of inotrope necessity in CS. At this time, inotrope selection should be guided by physician experience, availability, cost, and most importantly, individual patients’ response to therapy. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.